Provider Demographics
NPI:1760429096
Name:SIMONS, KENNETH NEIL (PT,DPT, MS,OCS)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:NEIL
Last Name:SIMONS
Suffix:
Gender:M
Credentials:PT,DPT, MS,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3606
Mailing Address - Country:US
Mailing Address - Phone:207-324-6789
Mailing Address - Fax:844-292-4021
Practice Address - Street 1:1068 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3606
Practice Address - Country:US
Practice Address - Phone:207-324-6789
Practice Address - Fax:207-324-9394
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT9662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041390OtherAETNA
ME277030099Medicaid
ME034720OtherANTHEM
ME048994OtherANTHEM
MEMM5161Medicare ID - Type UnspecifiedPHYSICAL THERAPIST