Provider Demographics
NPI:1205145901
Name:SIMON, ROXANNE E (DPT)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3419
Mailing Address - Country:US
Mailing Address - Phone:410-456-5287
Mailing Address - Fax:
Practice Address - Street 1:100 S CHARLES ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2725
Practice Address - Country:US
Practice Address - Phone:410-752-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist