Provider Demographics
NPI:1932725488
Name:JEAN-SIMON, JESLINE
Entity Type:Individual
Prefix:
First Name:JESLINE
Middle Name:
Last Name:JEAN-SIMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 NE 2ND CT # 1A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2827
Mailing Address - Country:US
Mailing Address - Phone:305-495-6063
Mailing Address - Fax:
Practice Address - Street 1:14200 NE 2ND CT # 1A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2827
Practice Address - Country:US
Practice Address - Phone:305-495-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23747225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant