MEDICARE: WANDA SIMMONS PHYSICAL THERAPY, P.C.

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	225100000X	Physical Therapist	0001791	CO

General Provider Information

NPI Number	:	1245578970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDA SIMMONS PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 2120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1197
Country	:	US
Telephone Number	:	970-988-2321
Fax Number	:	970-682-6447

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 2120
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1197
Country	:	US
Telephone Number	:	970-988-2321
Fax Number	:	970-682-6447

Authorized Official
Title or Position	:	OWNER
Name	:	WANDA K SIMMONS-PARSONNET
Credential	:	PT
Telephone Number	:	970-988-2321

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	06/23/2022

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