MEDICARE: MRS. CATHERINE L SIMON P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7114	OH

General Provider Information

NPI Number	:	1023176294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE L SIMON P.T.

Provider Business Mailing Address
First Line	:	313 BRYDON RD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-1704
Country	:	US
Telephone Number	:	937-474-4424
Fax Number	:	937-298-6046

Provider Business Practice Location Address
First Line	:	313 BRYDON RD
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45419-1704
Country	:	US
Telephone Number	:	937-474-4424
Fax Number	:	937-298-6046

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	01/30/2019

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