Provider Demographics
NPI:1467888065
Name:SIMMONS, JESSE JAMES (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JAMES
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-573-0550
Mailing Address - Fax:858-573-0551
Practice Address - Street 1:9610 GRANITE RIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2684
Practice Address - Country:US
Practice Address - Phone:858-573-0550
Practice Address - Fax:858-573-0551
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist