MEDICARE: STACIE BETH SIMKO 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	2251P0200X	Pediatric Physical Therapist	006128	CT

General Provider Information

NPI Number	:	1518934892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIE BETH SIMKO PT

Provider Business Mailing Address
First Line	:	124 WOLF HILL RD
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-1192
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 WOLF HILL RD
Second Line	:
City	:	COVENTRY
State	:	CT
Zip	:	06238-1192
Country	:	US
Telephone Number	:	860-742-9653
Fax Number	:

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

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	02/22/2015

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Directions to “ STACIE BETH SIMKO PT” Practice Location

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