Provider Demographics
NPI:1528111945
Name:SIMPSON, JILL DIANE (CPT)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:DIANE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5664
Mailing Address - Country:US
Mailing Address - Phone:504-889-2663
Mailing Address - Fax:504-889-5615
Practice Address - Street 1:671 W ESPLANADE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2794
Practice Address - Country:US
Practice Address - Phone:504-467-5900
Practice Address - Fax:504-467-7272
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist