Provider Demographics
NPI:1003223728
Name:SIMONE, KATHLEEN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-6500
Mailing Address - Country:US
Mailing Address - Phone:727-698-3485
Mailing Address - Fax:205-665-6614
Practice Address - Street 1:1090 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-6500
Practice Address - Country:US
Practice Address - Phone:727-698-3485
Practice Address - Fax:205-665-6614
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer