MEDICARE: LYNN MARIE SIMONS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11-02947	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140971	OTHER	KS	KS BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063558674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN MARIE SIMONS PT

Provider Business Mailing Address
First Line	:	307 IRENE AVE
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-9210
Country	:	US
Telephone Number	:	316-535-1101
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 N 5TH AVE
Second Line	:
City	:	ANTHONY
State	:	KS
Zip	:	67003-2106
Country	:	US
Telephone Number	:	620-842-5187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	11/20/2024

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