Provider Demographics
NPI:1083813372
Name:HEALTHSUMMIT PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:HEALTHSUMMIT PHYSICAL THERAPY, INC.
Other - Org Name:HEALTHSUMMIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DR. OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LINTAG
Authorized Official - Last Name:MEKATA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:650-823-2152
Mailing Address - Street 1:260 S SUNNYVALE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6287
Mailing Address - Country:US
Mailing Address - Phone:408-329-9604
Mailing Address - Fax:408-262-1321
Practice Address - Street 1:260 S SUNNYVALE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6287
Practice Address - Country:US
Practice Address - Phone:408-329-9604
Practice Address - Fax:408-262-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23271261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05453ZMedicare UPIN