Provider Demographics
NPI:1669440046
Name:SPEYER, SIMONE (DPT,AP,DOM)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:SPEYER
Suffix:
Gender:F
Credentials:DPT,AP,DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11336 NW 14TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2639
Mailing Address - Country:US
Mailing Address - Phone:954-732-4592
Mailing Address - Fax:
Practice Address - Street 1:454 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6720
Practice Address - Country:US
Practice Address - Phone:954-443-1926
Practice Address - Fax:954-443-1936
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP701171100000X
FLPT4419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3877ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER