Basic Information
| Provider Information | |||||||||
| NPI: | 1447374244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMONTON | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | NELL | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13897 CR 209 | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527485866 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 N BLVD WEST | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527879300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 13547 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.