Provider Demographics
NPI:1285861898
Name:SUMMERS, GLEN A (MSPT)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:A
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9583 EASTERN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:VA
Mailing Address - Zip Code:22728-1803
Mailing Address - Country:US
Mailing Address - Phone:609-682-0594
Mailing Address - Fax:
Practice Address - Street 1:9583 EASTERN VIEW LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:VA
Practice Address - Zip Code:22728-1803
Practice Address - Country:US
Practice Address - Phone:609-682-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2302225100000X
MEPT3388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist