Provider Demographics
NPI:1972555969
Name:SIMON, LEWIS J (KINESIOTHERAPIST)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:J
Last Name:SIMON
Suffix:
Gender:M
Credentials:KINESIOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7124 LAUREL WOOD DR
Mailing Address - Street 2:3701 LOOP ROAD EAST
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-6753
Mailing Address - Country:US
Mailing Address - Phone:205-759-1815
Mailing Address - Fax:
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-3780
Practice Address - Fax:205-554-2042
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1239226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist