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General NPI Number Information
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NPI Number | 1750455697
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Entity Type | Individual
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Provider Name | DIANA JOYCE SIMMS CMT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 106 10TH AVE
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City | BALTIMORE
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State | MD
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Zip | 21225-2919
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Country | US
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Telephone | 410-456-2269
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Fax | 410-609-0239
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Provider Business Mailing Address
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Address Line | 106 10TH AVE
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City | BALTIMORE
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State | MD
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Zip | 21225-2919
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M 03264
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License Number State | MD
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