Provider Demographics
NPI:1952183998
Name:SIMMONS, JASMINE (LMT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12020 BIRCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4198
Mailing Address - Country:US
Mailing Address - Phone:202-845-0786
Mailing Address - Fax:
Practice Address - Street 1:4400 STAMP RD STE 202
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6728
Practice Address - Country:US
Practice Address - Phone:202-845-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist