Healthcare Provider Details

I. General information

NPI: 1629950100
Provider Name (Legal Business Name): GABRIELLE NICHOLE SIMMS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CALVIN MURPHY DR
NORWALK CT
06851-5500
US

IV. Provider business mailing address

413 W ANDERSON AVE
PHOENIXVILLE PA
19460-4304
US

V. Phone/Fax

Practice location:
  • Phone: 203-838-4481
  • Fax:
Mailing address:
  • Phone: 215-588-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1957
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: