Provider Demographics
NPI:1164798328
Name:SIMMONS, BERNARD JOSHUA (PT)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:JOSHUA
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 BELLFIELD AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3160
Mailing Address - Country:US
Mailing Address - Phone:216-269-2850
Mailing Address - Fax:
Practice Address - Street 1:2280 BELLFIELD AVE
Practice Address - Street 2:APT. 2
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3160
Practice Address - Country:US
Practice Address - Phone:216-269-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.012054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist