Provider Demographics
NPI:1760610778
Name:SIMMS, ASHLEYROSE COSTELLO (DPT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEYROSE
Middle Name:COSTELLO
Last Name:SIMMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23444 ARCADIA FARM RD
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-6002
Mailing Address - Country:US
Mailing Address - Phone:646-707-2705
Mailing Address - Fax:
Practice Address - Street 1:2040 GAUSE BLEVD EAST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-280-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031518-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist