Provider Demographics
NPI:1073989562
Name:SUMMIT WELLNESS CENTERS, INC
Entity Type:Organization
Organization Name:SUMMIT WELLNESS CENTERS, INC
Other - Org Name:THE SUMMIT PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:559-896-6565
Mailing Address - Street 1:2660 WHITSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2622
Mailing Address - Country:US
Mailing Address - Phone:559-896-6565
Mailing Address - Fax:559-896-5740
Practice Address - Street 1:2660 WHITSON ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2622
Practice Address - Country:US
Practice Address - Phone:559-896-6565
Practice Address - Fax:559-896-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21942261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy