Provider Demographics
NPI:1144566175
Name:SIMONE, ANTHONY P (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:SIMONE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S FEDERAL HWY UNIT 99
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33008-6004
Mailing Address - Country:US
Mailing Address - Phone:954-646-3343
Mailing Address - Fax:
Practice Address - Street 1:500 S FEDERAL HWY UNIT 99
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33008-6004
Practice Address - Country:US
Practice Address - Phone:954-646-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist