Individual provider Active NPI

Michael Jay Simmons, MPT

  • Physical Therapist
  • Villa Rica, GA
National Provider Identifier
1528358355
Registry record updated Aug 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
007600 Issued in GA
Practice address
2740 Nautical Way
Villa Rica, GA 30180-8490
Phone
(770) 456-4435
NPI assigned
Apr 13, 2011
Last updated
Aug 26, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 007600 GA Primary

Addresses

Primary practice location

2740 Nautical Way
Villa Rica, GA 30180-8490

Mailing address

2740 Nautical Way
Villa Rica, GA 30180-8490
Phone (770) 456-4435

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210428002570 GA Practitioner - Physical Therapist in Private Practice 9234548421 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007600GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Pathways Preferred of Tennessee LLC Physical Therapist CurrentSince Apr 1, 2021 Accepting new patients
Broad River Rehabilitation Physical Therapist CurrentSince Jul 18, 2023 Accepting new patients

Locations

500 Eagle Lake Trl
Rome, GA 30165
Phone (706) 728-3600

1 Pond St
Arden, NC 28704
Phone 82877452220027

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2849

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345939200000",
    "number": "1528358355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 NAUTICAL WAY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301808490",
            "telephone_number": "770-456-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 NAUTICAL WAY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301808490",
            "telephone_number": "770-456-4435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMMONS",
        "first_name": "MICHAEL",
        "middle_name": "JAY",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-13",
        "last_updated": "2012-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "007600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.