Russell Simmons

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A-1331 Issued in NV

Practice address

1225 Triumph CT
Las Vegas, NV 89117-7122

Phone

(248) 930-2554

NPI assigned

Jan 25, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids Therapy Place, LLC

  • Occupational Therapist
  • Las Vegas, NV
  • NPI 1952068363
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674604800000",
    "number": "1609582576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8777 W MAULE AVE UNIT 2012",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484874",
            "telephone_number": "631-404-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 TRIUMPH CT",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177122",
            "telephone_number": "248-930-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "RUSSELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NV",
            "license": "A-1331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonard Simmons
• Monica Simmons
• Nicole Simmons
• Reginald Simmons
• Roosevelt Simmons
• Sandra Ellen Simmons, LPN
• Shawnte Simmons
• Sonia Simmons
• Terrence Delaney Simmons
• Terri Simmons

• Physical Therapy Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physical Therapy Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.