Provider Demographics
NPI:1174006613
Name:SIMON, COURTNEY DAWN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:DAWN
Last Name:SIMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 E CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2560
Mailing Address - Country:US
Mailing Address - Phone:316-636-4410
Mailing Address - Fax:316-636-2400
Practice Address - Street 1:9360 E CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-636-4410
Practice Address - Fax:316-636-2400
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist