Jake Simon

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25194 Issued in MA

Practice address

22 Berry Rd
Nottingham, NH 03290-5402

Phone

(617) 990-4929

NPI assigned

Jun 18, 2018

Last updated

Sep 10, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1871087551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BERRY RD",
            "city": "NOTTINGHAM",
            "state": "NH",
            "postal_code": "032905402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BERRY RD",
            "city": "NOTTINGHAM",
            "state": "NH",
            "postal_code": "032905402",
            "telephone_number": "617-990-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "JAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "25194",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "3253",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Ann North
• Nottingham School District
• Taylor A Pettigrew
• Resilient Roots Counseling
• Diana L Robinson, R.D.
• Amanda Stahl, OTR/L
• Town of Nottingham (Nottingham Fire-Rescue)
• Tracy Lee Walsh, CCC-SLP
• Rylee Weinstein, OTR/L
• Samantha Rae Yeaton

• Physical Therapist in Nottingham, NH
• Providers in Nottingham, NH by specialty
• Physical Therapist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.