Provider Demographics
NPI:1588861025
Name:SIMMONS, MELISSA DAWN (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAWN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209
Mailing Address - Country:US
Mailing Address - Phone:910-828-4002
Mailing Address - Fax:
Practice Address - Street 1:407 LAMBERT RD
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209
Practice Address - Country:US
Practice Address - Phone:910-428-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2197225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant