Provider Demographics
NPI:1063558674
Name:SIMONS, LYNN MARIE (PT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:SIMONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:307 IRENE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN PLAIN
Mailing Address - State:KS
Mailing Address - Zip Code:67050-9210
Mailing Address - Country:US
Mailing Address - Phone:316-535-1101
Mailing Address - Fax:
Practice Address - Street 1:212 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2106
Practice Address - Country:US
Practice Address - Phone:620-842-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140971OtherKS BLUE CROSS BLUE SHIELD