Provider Demographics
NPI:1376842823
Name:SUMMIT PHYSICAL THERAPY SERVICES INC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY SERVICES INC
Other - Org Name:SUMMIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-709-6161
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-1549
Mailing Address - Country:US
Mailing Address - Phone:760-709-6161
Mailing Address - Fax:760-929-2612
Practice Address - Street 1:51 CLUB DRIVE
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:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty