MEDICARE: MRS. SUE LYN SIMPSON P.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	02268	LA

General Provider Information

NPI Number	:	1265632681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUE LYN SIMPSON P.T.

Provider Business Mailing Address
First Line	:	45154 BATEMAN LN
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-4236
Country	:	US
Telephone Number	:	225-715-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	45154 BATEMAN LN
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-4236
Country	:	US
Telephone Number	:	225-715-9333
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	11/24/2018

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