Healthcare Provider Details

I. General information

NPI: 1891827101
Provider Name (Legal Business Name): DANIEL SIMS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6564 SE LAKE RD STE 101
MILWAUKIE OR
97222-2138
US

IV. Provider business mailing address

6564 SE LAKE RD STE 101
MILWAUKIE OR
97222-2138
US

V. Phone/Fax

Practice location:
  • Phone: 503-236-2303
  • Fax: 503-236-2614
Mailing address:
  • Phone: 503-236-2303
  • Fax: 503-236-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1096
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT1994
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: