Individual
COLLEEN M SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2850 JOHNSON FERRY RD STE 100, MARIETTA, GA 30062-5684
(770) 643-0868
Mailing address
5209 SANDLEWOOD CT, MARIETTA, GA 30068-2887
(770) 643-0868
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6944
GA
2251P0200X
Pediatric Physical Therapist
Primary
6944
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT006944
PROFESSIONAL LICENSING (PHYSICAL THERAPY LICENSE)
GA
Enumeration date
10/07/2019
Last updated
10/07/2019
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