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General NPI Number Information
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NPI Number | 1750770798
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Entity Type | Individual
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Provider Name | AMBER MACKENZIE SIMMONS ATC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 800 S MAIN ST
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City | HARRISONBURG
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State | VA
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Zip | 22807-0001
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Country | US
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Telephone | 330-819-5099
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Fax |
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Provider Business Mailing Address
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Address Line | 336 FIRWOOD AVE
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221-2312
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Country | US
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Telephone | 330-819-5099
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126002285
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License Number State | VA
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