Provider Demographics
NPI:1063601359
Name:SIMON, DEBRA KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KATHLEEN
Last Name:SIMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 RESERVOIR BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3255
Mailing Address - Country:US
Mailing Address - Phone:763-782-1657
Mailing Address - Fax:
Practice Address - Street 1:4444 RESERVOIR BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3255
Practice Address - Country:US
Practice Address - Phone:763-782-1657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist