Roosevelt Dominic Simmons, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61572474 Issued in WA

Practice address

4400 Stone Way N
Seattle, WA 98103-7485

Phone

(206) 536-3049

NPI assigned

Sep 18, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Roosevelt Kai Simmons Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1063249456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4509 LINDEN AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981036531",
            "telephone_number": "951-249-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 STONE WAY N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981037485",
            "telephone_number": "206-536-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "ROOSEVELT",
        "middle_name": "DOMINIC",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61572474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROOSEVELT KAI",
            "last_name": "SIMMONS",
            "credential": "DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joshua Brett Simmons
• Kelly Simmons
• Kimberly B Simmons, MD, MPH
• Matthew Excel Simmons
• Molly Simmons
• Ryan Elizabeth Simmons, D.P.T.
• Sarah Beth Simmons, M.D.
• Sarah Diane Simmons, BA, BS
• Shannon Wagner Simmons, MD
• William Cris Simmons, DDS

• Physical Therapist in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.