MEDICARE: CATHIE ELLEN SIMON 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	015929-1	NY

General Provider Information

NPI Number	:	1851371140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHIE ELLEN SIMON PT

Provider Business Mailing Address
First Line	:	68 DEER LN
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-2970
Country	:	US
Telephone Number	:	631-467-4235
Fax Number	:	631-467-2655

Provider Business Practice Location Address
First Line	:	1133 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-2918
Country	:	US
Telephone Number	:	631-467-4235
Fax Number	:	631-467-2655

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	11/06/2008

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Directions to “ CATHIE ELLEN SIMON PT” Practice Location

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