Doctor Name: | MR. MATT SIMMONS |
NPI Number: | 1225416886 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT, LR |
License Number: | 1361 |
Business Practice Address: | 4955 17th Ave S Ste 116 Fargo, ND - 581033372 |
Business Phone Number: | 7018933888 |
Business Fax Number: | |
Mailing Address: | 1806 56th Ave S, FARGO |
State: | ND |
Postal Code: | 581046386 |
Phone Number: | 7015203154 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2015 |
NPI Last Update Date: | 05/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 1361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |