Provider Demographics
| NPI: | 1093035156 |
|---|---|
| Name: | BRYAN S. DENNISON |
| Entity Type: | Organization |
| Organization Name: | BRYAN S. DENNISON |
| Other - Org Name: | SUMMIT PHYSICAL THERAPY |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PHYSICAL THERAPIST (OWNER) |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | BRYAN |
| Authorized Official - Middle Name: | SHAWN |
| Authorized Official - Last Name: | DENNISON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT, DPT |
| Authorized Official - Phone: | 310-488-6706 |
| Mailing Address - Street 1: | PO BOX 682 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MAMMOTH LAKES |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 93546-0682 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 760-709-6161 |
| Mailing Address - Fax: | 760-929-2612 |
| Practice Address - Street 1: | 51 CLUB DR. |
| Practice Address - Street 2: | |
| Practice Address - City: | MAMMOTH LAKES |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 93546 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 760-709-6161 |
| Practice Address - Fax: | 760-929-2612 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-06-10 |
| Last Update Date: | 2011-01-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | PT 28289 | 225100000X, 2251E1200X, 2251G0304X, 2251H1200X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Multi-Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
