MEDICARE: KRISTI SIMMONS PTA

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	225200000X	Physical Therapy Assistant	PTA3956	AR

General Provider Information

NPI Number	:	1265209175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI SIMMONS PTA

Provider Business Mailing Address
First Line	:	2120 PINEWOOD DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-5227
Country	:	US
Telephone Number	:	615-720-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 PINEWOOD DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-5227
Country	:	US
Telephone Number	:	615-720-7994
Fax Number	:

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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