Provider Demographics
NPI:1477335222
Name:SUMMIT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:NASVYTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:312-307-2339
Mailing Address - Street 1:11 ERVEN RD
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-9303
Mailing Address - Country:US
Mailing Address - Phone:312-307-2339
Mailing Address - Fax:
Practice Address - Street 1:11 ERVEN RD
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-9303
Practice Address - Country:US
Practice Address - Phone:312-307-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy