MEDICARE: MRS. TAMMY MARIE SIMMONS MHS, PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	05002124A	IN
2	2251P0200X	Pediatric Physical Therapist	05002124A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000369371	OTHER	IN	ANTHEM BC/BS

General Provider Information

NPI Number	:	1164401709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY MARIE SIMMONS MHS, PT

Provider Business Mailing Address
First Line	:	3610 S HOMESTEAD DR
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9438
Country	:	US
Telephone Number	:	317-965-3483
Fax Number	:	317-806-7804

Provider Business Practice Location Address
First Line	:	6239 S EAST ST
Second Line	:	A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2090
Country	:	US
Telephone Number	:	317-791-9031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/29/2016

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