MEDICARE: SIMON UN DPT

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	PT40784	FL

General Provider Information

NPI Number	:	1982483442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON UN DPT

Provider Business Mailing Address
First Line	:	3117 BIRD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4427
Country	:	US
Telephone Number	:	305-935-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 BIRD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4427
Country	:	US
Telephone Number	:	305-282-2689
Fax Number	:

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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Directions to “ SIMON UN DPT” Practice Location

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