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NPI Code Detail

MEDICARE: MONIQUE SIMMONS DILLARD PT

MEDICARE: MONIQUE SIMMONS DILLARD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1171163TX
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1790908572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIQUE SIMMONS DILLARD PT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2838 E ATLANTA RD STE 2
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2780
Country : US
Telephone Number : 678-782-3609
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 01/15/2024

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