Provider Demographics
NPI:1467571513
Name:SUMMIT REHABILITATION ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SUMMIT REHABILITATION ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, ATP, CEES
Authorized Official - Phone:509-455-6002
Mailing Address - Street 1:407 E 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1428
Mailing Address - Country:US
Mailing Address - Phone:509-455-6002
Mailing Address - Fax:
Practice Address - Street 1:407 E 2ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1428
Practice Address - Country:US
Practice Address - Phone:509-455-6002
Practice Address - Fax:509-747-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7682131Medicaid
WA7087216Medicaid
WA115084OtherLABOR & INDUSTRIES
WA1256230001Medicare NSC
WA115084OtherLABOR & INDUSTRIES
WA7087216Medicaid