Provider Demographics
NPI:1821438755
Name:SIMONCINI, VALERIE ALICE (LMT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ALICE
Last Name:SIMONCINI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 SECRETARIAT CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6044
Mailing Address - Country:US
Mailing Address - Phone:770-888-8136
Mailing Address - Fax:
Practice Address - Street 1:5755 NORTHPOINT PKWY
Practice Address - Street 2:SUITE 56
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1142
Practice Address - Country:US
Practice Address - Phone:678-528-1652
Practice Address - Fax:678-528-9612
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT008526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist