Provider Demographics
NPI:1518214105
Name:SIMMONS, ASHLEY M (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SALTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4014
Mailing Address - Country:US
Mailing Address - Phone:410-991-6978
Mailing Address - Fax:410-544-7941
Practice Address - Street 1:537 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:STE D
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3812
Practice Address - Country:US
Practice Address - Phone:410-544-8444
Practice Address - Fax:410-544-7941
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13683367OtherCAQH
MD105736700Medicaid
13683367OtherCAQH