MEDICARE: MRS. APOLLONE SIMONE REID P.T., MPH

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	PT001355	GA

General Provider Information

NPI Number	:	1295722205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. APOLLONE SIMONE REID P.T., MPH

Provider Business Mailing Address
First Line	:	718 SMALL ELK CT
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1022
Country	:	US
Telephone Number	:	404-518-8206
Fax Number	:	404-292-4452

Provider Business Practice Location Address
First Line	:	718 SMALL ELK CT
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-1022
Country	:	US
Telephone Number	:	404-518-8206
Fax Number	:	404-292-4452

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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