Individual
ETHAN SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1830 S 44TH ST, DECATUR, IL 62521-5147
(217) 423-2784
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4163
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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