Healthcare Provider Details

I. General information

NPI: 1295122703
Provider Name (Legal Business Name): BRETT AARON SIMON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 S COMMERCIAL ST
HARRISONVILLE MO
64701-1784
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-3325
  • Fax: 816-380-3044
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2014039473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: