Healthcare Provider Details

I. General information

NPI: 1184285991
Provider Name (Legal Business Name): DAVID SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2019
Last Update Date: 12/07/2019
Certification Date: 12/07/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 OLD REDWOOD HWY STE 152
SANTA ROSA CA
95403-1719
US

IV. Provider business mailing address

160 JOHN REZZA DR
ATTLEBORO FALLS MA
02763-4052
US

V. Phone/Fax

Practice location:
  • Phone: 707-566-5857
  • Fax:
Mailing address:
  • Phone: 508-510-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0013705
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT296573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: