Provider Demographics
NPI:1528210184
Name:SIMONE, CRAIG MICHAEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MICHAEL
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 1:2462 BLACKBURN CIR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3140
Mailing Address - Country:US
Mailing Address - Phone:239-283-9260
Mailing Address - Fax:
Practice Address - Street 1:4422 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7439
Practice Address - Country:US
Practice Address - Phone:239-945-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0013710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0013710OtherMASSAGE THERAPY LICENSE