Provider Demographics
NPI:1780837252
Name:SIMMONS, JENNIFER R (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 HAIGHT AVE
Mailing Address - Street 2:#2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1503
Mailing Address - Country:US
Mailing Address - Phone:914-282-7585
Mailing Address - Fax:347-293-6777
Practice Address - Street 1:1623 HAIGHT AVE
Practice Address - Street 2:#2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1503
Practice Address - Country:US
Practice Address - Phone:914-282-7585
Practice Address - Fax:347-293-6777
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017686-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics