Provider Demographics
NPI:1184061087
Name:JENNIFER R. SIMMONS, PT, PC
Entity type:Organization
Organization Name:JENNIFER R. SIMMONS, PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:914-282-7585
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017686-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty