Provider Demographics
NPI:1891880746
Name:MEADE, SIMONNE BRESCH (MPT)
Entity type:Individual
Prefix:MISS
First Name:SIMONNE
Middle Name:BRESCH
Last Name:MEADE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-2029
Mailing Address - Country:US
Mailing Address - Phone:804-529-5178
Mailing Address - Fax:
Practice Address - Street 1:2126 GREAT NECK SQ
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2202
Practice Address - Country:US
Practice Address - Phone:757-578-2197
Practice Address - Fax:757-578-2330
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010151225100000X
VA2305202647225100000X
NCP11637225100000X
CA37718225100000X
SC5735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
388305OtherCHAMPUS