Healthcare Provider Details

I. General information

NPI: 1801891981
Provider Name (Legal Business Name): DEBORAH E. SIMONCEK PT, ECS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

IV. Provider business mailing address

308 STUDENT HEALTH CENTER
UNIVERSITY PARK PA
16802
US

V. Phone/Fax

Practice location:
  • Phone: 814-863-6747
  • Fax: 814-863-8464
Mailing address:
  • Phone: 814-863-6747
  • Fax: 814-863-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007156L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: