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General NPI Number Information
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NPI Number | 1114742467
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Entity Type | Individual
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Provider Name | STEVE SIMO
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Gender | Male
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 302 N INDEPENDENCE ST STE 802
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City | ENID
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State | OK
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Zip | 73701-4046
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Country | US
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Telephone | 580-334-1856
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Fax | 580-789-9113
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Provider Business Mailing Address
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Address Line | 302 N INDEPENDENCE ST STE 802
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City | ENID
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State | OK
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Zip | 73701-4046
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Country | US
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Telephone | 580-334-1856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3291
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License Number State | OK
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