Basic Information
| Provider Information | |||||||||
| NPI: | 1174077176 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIMEONE | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10705 CARDINGTON WAY | ||||||||
| Address2: | APT T2 | ||||||||
| City: | COCKEYSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210303065 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 14700 BALTIMORE AVE | ||||||||
| Address2: | #106 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207074877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2407542203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2016 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | A0000846 | MD | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.