MEDICARE: JANINE MARIE SIMON M.P.T., C.L.T.

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	PT00010416	WA

General Provider Information

NPI Number	:	1144228313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE MARIE SIMON M.P.T., C.L.T.

Provider Business Mailing Address
First Line	:	16030 BOTHELL EVERETT HWY
Second Line	:	STE #200
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1741
Country	:	US
Telephone Number	:	425-745-4910
Fax Number	:	425-338-5709

Provider Business Practice Location Address
First Line	:	16030 BOTHELL EVERETT HWY
Second Line	:	STE #200
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1741
Country	:	US
Telephone Number	:	425-745-4910
Fax Number	:	425-338-5709

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	09/19/2007

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