Healthcare Provider Details

I. General information

NPI: 1215855861
Provider Name (Legal Business Name): JOSE ANGELITO SIMPAO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JOHN KISSINGER DR
WABASH IN
46992-1648
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR MAILBOX 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003504A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: