Provider Demographics
NPI:1093770588
Name:SIMEONE, JAMES PAUL (PTA BBA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PAUL
Last Name:SIMEONE
Suffix:
Gender:M
Credentials:PTA BBA
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Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23655 NOVI RD STE 101
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5442
Practice Address - Country:US
Practice Address - Phone:248-277-3440
Practice Address - Fax:248-277-3441
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502003165225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant