Provider Demographics
NPI:1174077176
Name:SIMEONE, JESSICA (ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SIMEONE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 CARDINGTON WAY
Mailing Address - Street 2:APT T2
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14700 BALTIMORE AVE
Practice Address - Street 2:#106
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4877
Practice Address - Country:US
Practice Address - Phone:240-754-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00008462081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine