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General NPI Number Information
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NPI Number | 1699581892
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Entity Type | Individual
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Provider Name | DEVON MARSHAL SIMMONS
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1001 VAN BUREN AVE
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5541
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Country | US
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Telephone | 704-628-6053
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Fax | 704-628-6702
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Provider Business Mailing Address
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Address Line | 2020 ASPEN WAY CT
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City | GASTONIA
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State | NC
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Zip | 28054-0028
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Country | US
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Telephone | 707-293-5515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A6999
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License Number State | NC
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