Provider Demographics
NPI:1609081199
Name:SIMMONS, MARY GEORGEINA (PT CLT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GEORGEINA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PT CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12714 ANDY ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6045
Mailing Address - Country:US
Mailing Address - Phone:562-822-1140
Mailing Address - Fax:
Practice Address - Street 1:12714 ANDY ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6045
Practice Address - Country:US
Practice Address - Phone:562-822-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6296225100000X
CT010712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist