Provider Demographics
NPI:1639447295
Name:SIMMERMAKER, DARRELL B (MS, PTA)
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:B
Last Name:SIMMERMAKER
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Gender:M
Credentials:MS, PTA
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Mailing Address - Street 1:2921 GREENBRIAR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6421
Mailing Address - Country:US
Mailing Address - Phone:217-546-3301
Mailing Address - Fax:217-546-3302
Practice Address - Street 1:2921 GREENBRIAR DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6421
Practice Address - Country:US
Practice Address - Phone:217-546-3301
Practice Address - Fax:217-546-3302
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
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Provider Licenses
StateLicense IDTaxonomies
IL160.005767225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant