Provider Demographics
NPI:1144228313
Name:SIMON, JANINE MARIE (MPT, CLT)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MPT, CLT
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, CLT
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY
Mailing Address - Street 2:STE #200
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1741
Mailing Address - Country:US
Mailing Address - Phone:425-745-4910
Mailing Address - Fax:425-338-5709
Practice Address - Street 1:16030 BOTHELL EVERETT HWY
Practice Address - Street 2:STE #200
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1741
Practice Address - Country:US
Practice Address - Phone:425-745-4910
Practice Address - Fax:425-338-5709
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007176A55Medicare ID - Type Unspecified