Provider Demographics
NPI:1720167083
Name:SIMBRO, JESSICA E (PT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:E
Last Name:SIMBRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E PACES FERRY RD NE
Mailing Address - Street 2:APT. 358
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1124
Mailing Address - Country:US
Mailing Address - Phone:404-441-4410
Mailing Address - Fax:404-299-1616
Practice Address - Street 1:1014 SYCAMORE DR
Practice Address - Street 2:STE. B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1644
Practice Address - Country:US
Practice Address - Phone:404-299-6060
Practice Address - Fax:404-299-1616
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0070552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT007055OtherSTATE BOARD OF P.T.