Provider Demographics
NPI:1235535428
Name:SIMCOCK, SUSAN (MS,PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SIMCOCK
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 MACOM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9358
Mailing Address - Country:US
Mailing Address - Phone:630-585-7337
Mailing Address - Fax:
Practice Address - Street 1:1315 MACOM DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9358
Practice Address - Country:US
Practice Address - Phone:630-585-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.001782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist