Provider Demographics
NPI:1609081199
Name:SIMMONS, MARY GEORGEINA (PT CLT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GEORGEINA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PT CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9353 IMPERIAL HWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2812
Mailing Address - Country:US
Mailing Address - Phone:562-657-2450
Mailing Address - Fax:562-657-2937
Practice Address - Street 1:9353 IMPERIAL HWY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-2408
Practice Address - Fax:562-657-2937
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist