Provider Demographics
NPI:1003969726
Name:JOHN SIMMONS P T P C
Entity Type:Organization
Organization Name:JOHN SIMMONS P T P C
Other - Org Name:SPORTS PT OF MANHASSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:631-266-1761
Mailing Address - Street 1:225 COMMUNITY DRIVE
Mailing Address - Street 2:SUITE 10 SPORTS PHYSICAL THERAPY OF MANHASSET
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-829-7639
Mailing Address - Fax:516-829-7352
Practice Address - Street 1:225 COMMUNITY DRIVE
Practice Address - Street 2:SUITE 10 SPORTS PHYSICAL THERAPY OF MANHASSET
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-829-7639
Practice Address - Fax:516-829-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86711Medicare PIN