Provider Demographics
NPI:1962779314
Name:SIMMONS, JACKIE (DPT)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5100 W ELDORADO PKWY
Mailing Address - Street 2:#102-20OPT
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:972-355-5200
Mailing Address - Fax:972-355-5800
Practice Address - Street 1:1121 FLOWER MOUND RD
Practice Address - Street 2:SUITE 540
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3651
Practice Address - Country:US
Practice Address - Phone:972-355-5200
Practice Address - Fax:972-355-5800
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist