Provider Demographics
NPI:1174915557
Name:SIMO, ADRIAN (MSATC, LMT)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:SIMO
Suffix:
Gender:M
Credentials:MSATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13380 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6907
Mailing Address - Country:US
Mailing Address - Phone:305-992-6685
Mailing Address - Fax:
Practice Address - Street 1:13380 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6907
Practice Address - Country:US
Practice Address - Phone:305-992-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA19189174400000X, 225700000X
FLAL1688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist