Simon Effat Ibrahim, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA3597 Issued in TN

Practice address

1480 E 3Rd St
Chattanooga, TN 37404-2434

Phone

(423) 622-2459

NPI assigned

Oct 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1083990659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 E 3RD ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374042434",
            "telephone_number": "423-622-2459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "SIMON",
        "middle_name": "EFFAT",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-27",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "PTA3597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glendon Alan Hyde, MD
• Jensen Hart Hyde, MD
• Karissa Hyrchuk, LCSW
• I Am Tiara Mitchell
• Ahmed A Ibrahim, M.D.
• Id Group, PLLC
• Corey David Idrogo, D.C.
• Osamuyi Idubor, DO
• Samuel Igbinedion
• Veronica Iglesias

• Physical Therapy Assistant in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.