Provider Demographics
NPI:1932415833
Name:HARGUS, SIMON (DPT)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:HARGUS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ROSEMAR RD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-7609
Mailing Address - Country:US
Mailing Address - Phone:304-696-2124
Mailing Address - Fax:
Practice Address - Street 1:2837 PIKE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-8658
Practice Address - Country:US
Practice Address - Phone:304-489-2230
Practice Address - Fax:304-489-9576
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist