Individual
MR. MARK DOUGLAS SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2560 N COUNTY ROAD 20 W, NORTH VERNON, IN 47265-8202
(812) 801-1362
Mailing address
2560 N COUNTY ROAD 20 W, CEDAR KNOLL FARMS, NORTH VERNON, IN 47265-8202
(812) 801-1362
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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