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Individual
KENROY LESLIE SIMMS
Active
Individual
KENROY LESLIE SIMMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
006206-1
NY
225100000X
Physical Therapist
Primary
036852
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006206-1
PTA LICENSE
NY
01
—
036852
PT LICENSE
NY
Enumeration date
05/03/2007
Last updated
01/11/2024
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