Active NPI
Dedra Simmons
- Physical Therapist
- Summerville, SC
National Provider Identifier
1508024704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5587
- Practice address
- 10160 Dorchester Rd
Summerville, SC 29485-8527 - Phone
- (843) 851-5820
- Fax
- (843) 832-6403
- NPI assigned
- May 26, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5587 | SC | Primary |
Addresses
Primary practice location
10160 Dorchester Rd
Summerville, SC 29485-8527
Mailing address
10160 Dorchester Rd
Summerville, SC 29485-8527
Phone (843) 851-5820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5587 | SC | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Progressive Phyiscal Therapy, PA | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Columbia, SC
- NPI 1487929105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211760000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211760000000",
"number": "1508024704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10160 DORCHESTER RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294858527",
"telephone_number": "843-851-5820",
"fax_number": "843-832-6403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10160 DORCHESTER RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294858527",
"telephone_number": "843-851-5820",
"fax_number": "843-832-6403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMMONS",
"first_name": "DEDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-26",
"last_updated": "2008-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "5587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.