Provider Demographics
NPI:1417068297
Name:SIMONDS, CHARLENE L (PT)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:L
Last Name:SIMONDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:L
Other - Last Name:LEVITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5715 DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6023
Mailing Address - Country:US
Mailing Address - Phone:410-591-3143
Mailing Address - Fax:410-833-0396
Practice Address - Street 1:5715 DEER PARK RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6023
Practice Address - Country:US
Practice Address - Phone:410-591-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist