Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 421 | NM |
N | 2251S0007X | Physical Therapist - Sports | 421 | NM |
N | 2251X0800X | Physical Therapist - Orthopedic | 421 | NM |
NPI | 1528154028 |
---|---|
Provider Name | Gerald Matthew Simmons |
First Address | Tijeras, NM 87059 |
Second Address | Albuquerque, NM 87110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000N5533 | (05) | NM |
00NMO1N618 | (02) | NM |
2353 | (02) | NM |