Provider Demographics
NPI:1407564321
Name:GAPPE, SIMON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:GAPPE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13488 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1366
Mailing Address - Country:US
Mailing Address - Phone:586-439-6243
Mailing Address - Fax:
Practice Address - Street 1:13488 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1366
Practice Address - Country:US
Practice Address - Phone:586-439-6243
Practice Address - Fax:586-439-6240
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist