MEDICARE: VICTOR F. SIMONETTA PT

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	007229	OH

General Provider Information

NPI Number	:	1538296819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR F. SIMONETTA PT

Provider Business Mailing Address
First Line	:	1527 WINCHESTER RD
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-2820
Country	:	US
Telephone Number	:	216-310-3065
Fax Number	:

Provider Business Practice Location Address
First Line	:	14775 BROADWAY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1103
Country	:	US
Telephone Number	:	216-475-7066
Fax Number	:	216-587-6853

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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Directions to “ VICTOR F. SIMONETTA PT” Practice Location

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