Provider Demographics
NPI:1215119078
Name:SIMNICK, SUSAN MARY (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:SIMNICK
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:PO BOX 9215
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-0215
Mailing Address - Country:US
Mailing Address - Phone:630-922-9680
Mailing Address - Fax:
Practice Address - Street 1:4624 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2655
Practice Address - Country:US
Practice Address - Phone:630-968-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist