MEDICARE: DOMINIQUE NICOLE SIMMONS DPT

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
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	PT014394	GA

General Provider Information

NPI Number	:	1881237410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE NICOLE SIMMONS DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	866-518-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 SCENIC HWY N STE C
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-6142
Country	:	US
Telephone Number	:	678-344-7197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2019
Last Update Date	:	11/25/2024

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