Provider Demographics
NPI:1104901826
Name:SIMCOX, MAUREEN ANNE (PT)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:SIMCOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ANNE
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 N KINGSBURY ST
Mailing Address - Street 2:2501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6940
Mailing Address - Country:US
Mailing Address - Phone:630-390-5614
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6731225100000X
IL070015552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist