Provider Demographics
NPI:1114742467
Name:SIMO, STEVE
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:SIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N INDEPENDENCE ST STE 802
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-4046
Mailing Address - Country:US
Mailing Address - Phone:580-334-1856
Mailing Address - Fax:
Practice Address - Street 1:302 N INDEPENDENCE ST STE 802
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4046
Practice Address - Country:US
Practice Address - Phone:580-334-1856
Practice Address - Fax:580-789-9113
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3291225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant