Provider Demographics
NPI:1598231003
Name:SIMMONS, JEFFREY (ACSM-CEP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 E PICKARD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2007
Mailing Address - Country:US
Mailing Address - Phone:989-256-0901
Mailing Address - Fax:
Practice Address - Street 1:4641 E PICKARD ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2007
Practice Address - Country:US
Practice Address - Phone:989-256-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1015821224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist