Provider Demographics
NPI:1164585774
Name:THERAPY MANAGEMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:THERAPY MANAGEMENT SERVICES, PLLC
Other - Org Name:SUMMIT PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CC
Authorized Official - Prefix:
Authorized Official - First Name:DWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-560-8157
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:813-560-8157
Mailing Address - Fax:425-450-0704
Practice Address - Street 1:3801 5TH ST SE STE 220
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2106
Practice Address - Country:US
Practice Address - Phone:253-445-4258
Practice Address - Fax:253-445-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730196676OtherNPI
WA8368854Medicaid
0180089OtherL & I
0185052OtherL & I
WA8341125Medicaid
1518031467OtherNPI
1821005760OtherNPI
WA8368946Medicaid
0189941OtherL & I
1649287582OtherNPI
WA8409393Medicaid
G8851161Medicare ID - Type Unspecified
WA8368854Medicaid
1649287582OtherNPI
G8808069Medicare ID - Type Unspecified