Provider Demographics
NPI:1346958774
Name:SIMONE, MARIA LAUREN (DPT, PT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LAUREN
Last Name:SIMONE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:586-997-0375
Mailing Address - Fax:586-997-0523
Practice Address - Street 1:43314 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-2022
Practice Address - Country:US
Practice Address - Phone:586-997-0375
Practice Address - Fax:586-997-0523
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049641-01225100000X
MI5501303443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist