Provider Demographics
NPI:1790850121
Name:SIMONS, DALLAS A (PT, SCS, ATC)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:A
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 RESTON PKWY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3388
Mailing Address - Country:US
Mailing Address - Phone:703-230-1760
Mailing Address - Fax:703-230-1761
Practice Address - Street 1:1760 RESTON PKWY
Practice Address - Street 2:SUITE 403
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3388
Practice Address - Country:US
Practice Address - Phone:703-230-1760
Practice Address - Fax:703-230-1761
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001881225100000X
VA01260000162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA216448ZBPFMedicare PIN