Healthcare Provider Details

I. General information

NPI: 1629706676
Provider Name (Legal Business Name): MICHAEL HARDY SIMPSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N EUCLID ST STE 680
ANAHEIM CA
92801-5509
US

IV. Provider business mailing address

3127 E 3RD ST APT 2
LONG BEACH CA
90814-6667
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0010
  • Fax:
Mailing address:
  • Phone: 360-909-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: