Provider Demographics
NPI:1609392364
Name:SIMMONS, LEAH RENEE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RENEE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 TOLEDO TER APT 211
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1392
Mailing Address - Country:US
Mailing Address - Phone:907-441-9215
Mailing Address - Fax:
Practice Address - Street 1:7000 ADELPHI RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1454
Practice Address - Country:US
Practice Address - Phone:907-441-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00012532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer