Healthcare Provider Details

I. General information

NPI: 1891025938
Provider Name (Legal Business Name): LAURA SIMMONS PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SCOTT LANE
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 8644
JACKSON WY
83002-8644
US

V. Phone/Fax

Practice location:
  • Phone: 307-690-5558
  • Fax: 307-734-8584
Mailing address:
  • Phone: 307-690-5558
  • Fax: 307-734-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1126
License Number StateWY

VIII. Authorized Official

Name: LAURA SIMMONS
Title or Position: OWNER/PRESIDENT
Credential: P.T.
Phone: 307-690-5558