Provider Demographics
NPI:1184634560
Name:SUMNER, ROBERT DAVID (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:SUMNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2517
Mailing Address - Country:US
Mailing Address - Phone:509-690-7620
Mailing Address - Fax:509-684-5081
Practice Address - Street 1:555 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2517
Practice Address - Country:US
Practice Address - Phone:509-690-7620
Practice Address - Fax:509-684-5081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist