Provider Demographics
NPI:1336539675
Name:SIMMONS, JULIE ABAMONGA (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ABAMONGA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JULIE ANN
Other - Middle Name:ABAMONGA
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:14296 S MAPLE RUN CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-1896
Mailing Address - Country:US
Mailing Address - Phone:832-917-0042
Mailing Address - Fax:
Practice Address - Street 1:3741 W 12600 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7215
Practice Address - Country:US
Practice Address - Phone:801-285-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-234225100000X
UT11334839-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist