Healthcare Provider Details

I. General information

NPI: 1922464486
Provider Name (Legal Business Name): LEE SIMON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 ENTERPRISE CT STE 200
BLOOMFIELD HILLS MI
48302-0311
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TOWNSHIP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 248-322-5280
  • Fax: 248-333-1915
Mailing address:
  • Phone: 586-350-2644
  • Fax: 586-416-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017536
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: