Individual provider Active NPI

Dyna A Simmons, PT

  • Physical Therapist
  • Pueblo, CO
National Provider Identifier
1396529988
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL0008400 Issued in CO
Practice address
4112 Outlook Blvd Ste 96
Pueblo, CO 81008-1667
Phone
(719) 562-6200
NPI assigned
Aug 23, 2023
Last updated
Aug 23, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 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

Enrollment IDStateProvider typePAC IDDetails
I20231011003767 CO Practitioner - Physical Therapist in Private Practice 1355796384 Reassigns benefits to 1 organization

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
Centura Ventures, LLCGroup PAC ID 8628989043, 30 clinicians

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

LicenseStateTypeSpecialty
PTL0008400COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centura Ventures, LLC Physical Therapist Current Accepting new patients
Centura Ventures, LLC CurrentSince Sep 12, 2023 Accepting new patients
Centura Ventures, LLC CurrentSince Sep 12, 2023 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.

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.

Verify at the official NPI Registry.