Provider Demographics
NPI:1053408427
Name:SIMMS, SHIRLEY AGAPITO (DPT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:AGAPITO
Last Name:SIMMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 OVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3510
Mailing Address - Country:US
Mailing Address - Phone:212-365-4237
Mailing Address - Fax:718-365-3749
Practice Address - Street 1:2971 OVERWOOD LN
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3510
Practice Address - Country:US
Practice Address - Phone:212-365-4237
Practice Address - Fax:718-365-3749
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028117OtherNY LICENSE
NY02937382Medicaid