MEDICARE: MRS. CAMILLE F SIMMONS PT, CMT

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	2305001325	VA

General Provider Information

NPI Number	:	1962457168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLE F SIMMONS PT, CMT

Provider Business Mailing Address
First Line	:	9447B LORTON MARKET ST
Second Line	:	SUITE 250
City	:	LORTON
State	:	VA
Zip	:	22079-1963
Country	:	US
Telephone Number	:	703-372-5716
Fax Number	:	703-372-5718

Provider Business Practice Location Address
First Line	:	5901 KINGSTOWNE VILLAGE PARKWAY
Second Line	:	SUITE 301
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315
Country	:	US
Telephone Number	:	703-924-2650
Fax Number	:	703-924-2653

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/10/2010

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