Individual
JAKE SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22 BERRY RD, NOTTINGHAM, NH 03290-5402
(617) 990-4929
Mailing address
22 BERRY RD, NOTTINGHAM, NH 03290-5402
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
25194
MA
2255A2300X
Athletic Trainer
3253
MA
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
06/18/2018
Last updated
09/10/2020
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