Individual
MRS. JEANNINE MARIE SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1810 MINNESOTA BLVD, SAINT CLOUD, MN 56304-2436
(320) 252-0010
Mailing address
1641 KENABEC ST, BIG LAKE, MN 55309-9412
(763) 291-9413
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A1953
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A1953
PHYSICAL THERAPIST ASSISTANT
MN
Enumeration date
07/19/2017
Last updated
07/19/2017
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