Provider Demographics
NPI:1578808283
Name:SIMIYU, MARY IRENE (PTA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:IRENE
Last Name:SIMIYU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:59 S WESTFIELD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2725
Mailing Address - Country:US
Mailing Address - Phone:571-435-7377
Mailing Address - Fax:
Practice Address - Street 1:45 LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2747
Practice Address - Country:US
Practice Address - Phone:413-536-8110
Practice Address - Fax:413-532-4731
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8442225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant