Individual
THERESA L SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPTA
Contact information
Practice address
622 N EDGEMOOR ST, WICHITA, KS 67208-3602
(316) 686-5100
Mailing address
509 GROVE ST, WAKEFIELD, KS 67487-9159
(785) 461-5417
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
62-1626490
KS
225200000X
Physical Therapy Assistant
Primary
14-01316
KS
Other
Enumeration date
03/07/2012
Last updated
09/01/2020
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