Healthcare Provider Details

I. General information

NPI: 1710969878
Provider Name (Legal Business Name): SHERYL L SIMKINS PT PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E MAIN ST STE C
BOZEMAN MT
59715-3726
US

IV. Provider business mailing address

612 E MAIN ST STE C
BOZEMAN MT
59715-3726
US

V. Phone/Fax

Practice location:
  • Phone: 406-522-3722
  • Fax: 406-522-0018
Mailing address:
  • Phone: 406-522-3722
  • Fax: 406-522-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number712PT
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number712PT
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number712PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: