Philip Simon, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12165 Issued in MN

Practice address

3390 Annapolis LN N
Plymouth, MN 55447-5378

Phone

(763) 767-0854

NPI assigned

Mar 4, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619136000000",
    "number": "1194310797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8935 UMBRIA PL N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111107",
            "telephone_number": "330-328-9142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 ANNAPOLIS LN N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554475378",
            "telephone_number": "763-767-0854"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Marymount Village Dr",
            "address_purpose": "LOCATION",
            "city": "Garfield Heights",
            "state": "OH",
            "postal_code": "441252973",
            "country_code": "US",
            "telephone_number": "216-332-1100 x1857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMON",
        "first_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-04-23",
        "certification_date": "2021-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT016727",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SHP V WSLG Plymouth LLC
• SHS-MN, Inc
• Rehan A Siddiqui, MD
• Avalon Sidney
• Robby Singh Sikka, M.D.
• Cristen Jayne Singer
• Kathryn Anne Singh
• Robert Michael Sinko, DDS
• Sisu Physical Therapy
• Sisu Physical Therapy PLLC

• Physical Therapist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.