MEDICARE: DR. JUSTIN CODY SIMON D.P.T., OCS

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	1234515	TX

General Provider Information

NPI Number	:	1760814164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN CODY SIMON D.P.T., OCS

Provider Business Mailing Address
First Line	:	801 E WILLIAM CANNON DR STE 225
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-6644
Country	:	US
Telephone Number	:	512-270-2060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 EVERETT DR STE 130
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-6332
Country	:	US
Telephone Number	:	512-738-8410
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	12/14/2018

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Directions to “ DR. JUSTIN CODY SIMON D.P.T., OCS” Practice Location

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