Provider Demographics
NPI:1700322237
Name:SIMON, KATHRYN MOLITOR (PT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MOLITOR
Last Name:SIMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 W LIEBAU RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3396
Mailing Address - Country:US
Mailing Address - Phone:262-243-4161
Mailing Address - Fax:262-243-4166
Practice Address - Street 1:1249 W LIEBAU RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3396
Practice Address - Country:US
Practice Address - Phone:262-243-4161
Practice Address - Fax:262-243-4166
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2439-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist