Healthcare Provider Details

I. General information

NPI: 1407989387
Provider Name (Legal Business Name): JOHN ELLIOT SIMONSEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 E UNIVERSITY AVE
DES MOINES IA
50317-8236
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 515-265-8272
  • Fax: 515-265-0176
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02932
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: