Healthcare Provider Details

I. General information

NPI: 1215561071
Provider Name (Legal Business Name): NICHOLAS E SIMMONS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8017 MESA DR STE 103
AUSTIN TX
78731-1313
US

IV. Provider business mailing address

14311 ANITA MARIE LN
AUSTIN TX
78728-6813
US

V. Phone/Fax

Practice location:
  • Phone: 512-791-3702
  • Fax:
Mailing address:
  • Phone: 512-800-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1329221
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: