Active NPI
Justin Cody Simon, D.P.T., OCS
- Physical Therapist
- Kyle, TX
National Provider Identifier
1760814164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1234515
- Practice address
- 4100 Everett Dr Ste 130
Kyle, TX 78640-6332 - Phone
- (512) 738-8410
- NPI assigned
- Aug 7, 2013
- Last updated
- Dec 14, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1234515 | TX | Primary |
Addresses
Primary practice location
4100 Everett Dr Ste 130
Kyle, TX 78640-6332
Mailing address
801 E William Cannon Dr Ste 225
Austin, TX 78745-6644
Phone (512) 270-2060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1234515 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544745600000",
"number": "1760814164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 E WILLIAM CANNON DR STE 225",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787456644",
"telephone_number": "512-270-2060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 EVERETT DR STE 130",
"city": "KYLE",
"state": "TX",
"postal_code": "786406332",
"telephone_number": "512-738-8410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMON",
"first_name": "JUSTIN",
"middle_name": "CODY",
"name_prefix": "Dr.",
"credential": "D.P.T., OCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-07",
"last_updated": "2018-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1234515",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kyle, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.