Healthcare Provider Details

I. General information

NPI: 1306904537
Provider Name (Legal Business Name): LAURA ROHNERT SIMMONS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA ELIZABETH ROHNERT

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 MANCHESTER WAY NE
BROOKHAVEN GA
30319-4713
US

IV. Provider business mailing address

1194 MANCHESTER WAY NE
BROOKHAVEN GA
30319-4713
US

V. Phone/Fax

Practice location:
  • Phone: 404-491-0323
  • Fax: 404-738-1433
Mailing address:
  • Phone: 404-491-0323
  • Fax: 404-738-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number011282
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: