Active NPI
Dyna A Simmons, PT
- Physical Therapist
- Pueblo, CO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTL0008400
- Practice address
- 4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667 - Phone
- (719) 562-6200
- NPI assigned
- Aug 23, 2023
- Last updated
- Aug 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTL0008400 | CO | Primary |
Addresses
Primary practice location
4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667
Mailing address
4306 St Andrews Dr
Pueblo, CO 81001-1165
Phone (719) 766-3355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4112 Outlook Blvd
Pueblo, CO 81008-1667
Phone (719) 562-6200
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL0008400 | CO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centura Ventures, LLC | Physical Therapist | Current | Accepting new patients |
| Centura Ventures, LLC | Current | Accepting new patients | |
| Centura Ventures, LLC | Current | Accepting new patients |
Locations
9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193
11960 Lioness Way
Ste 150
Parker, CO 80134
Phone (303) 269-2893
4112 Outlook Blvd
Ste 325
Pueblo, CO 81008
Phone (719) 562-6300
4112 Outlook Blvd
Ste 96
Pueblo, CO 81008
Phone (719) 562-6200
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba CS Briargate at Sister
- Physical Therapy Clinic/Center
- Colorado Springs, CO
- NPI 1073882197
Physical Therapist
-
dba CS Langstaff Brown PT
- Physical Therapy Clinic/Center
- Woodland Park, CO
- NPI 1891327920
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1396529988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4306 ST ANDREWS DR",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011165",
"telephone_number": "719-766-3355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4112 OUTLOOK BLVD STE 96",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081667",
"telephone_number": "719-562-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "DYNA",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-23",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "CO",
"license": "PTL0008400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.