Provider Demographics
NPI:1528189016
Name:SUMNER FITNESS, INC.
Entity Type:Organization
Organization Name:SUMNER FITNESS, INC.
Other - Org Name:SUMNER FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'FLAHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-229-9110
Mailing Address - Street 1:4611 SANGAMORE RD STE K
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2547
Mailing Address - Country:US
Mailing Address - Phone:301-229-9110
Mailing Address - Fax:301-229-9465
Practice Address - Street 1:4611 SANGAMORE RD STE K
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2547
Practice Address - Country:US
Practice Address - Phone:301-229-9110
Practice Address - Fax:301-229-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01412OtherPROVIDER NUMBER