MEDICARE: WANDA K SIMMONS-PARSONNET PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1791	CO
2	225100000X	Physical Therapist	PTL0001791	CO

General Provider Information

NPI Number	:	1619058252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA K SIMMONS-PARSONNET PT

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 2120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1197
Country	:	US
Telephone Number	:	970-492-5161
Fax Number	:	970-682-6447

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 2120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1197
Country	:	US
Telephone Number	:	970-492-5161
Fax Number	:	970-682-6447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	12/21/2023

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