Provider Demographics
NPI:1366589434
Name:SIMON, KIMBERLY SUE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:SIMON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 LEWIS ACCESS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9502
Mailing Address - Country:US
Mailing Address - Phone:319-849-2062
Mailing Address - Fax:319-849-2067
Practice Address - Street 1:4215 LEWIS ACCESS RD STE 300
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:IA
Practice Address - Zip Code:52213-9502
Practice Address - Country:US
Practice Address - Phone:319-849-2062
Practice Address - Fax:319-849-2067
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39927OtherWELLMARK BLUE CROSS
IA161349Medicare ID - Type UnspecifiedMEDICARE