Individual
MR. MARK DOUGLAS SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002822A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05002822A
INDIANA PROFESSIONAL LICENSING AGENCY PHYSICAL THERAPY
IN
Enumeration date
02/07/2011
Last updated
02/07/2011
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