Provider Demographics
NPI:1558662940
Name:SUMMIT REHABILITATION, PLLC
Entity Type:Organization
Organization Name:SUMMIT REHABILITATION, PLLC
Other - Org Name:FALCON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-804-1712
Mailing Address - Street 1:1601 116TH AVE NE
Mailing Address - Street 2:101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3010
Mailing Address - Country:US
Mailing Address - Phone:425-502-7145
Mailing Address - Fax:425-502-7320
Practice Address - Street 1:10505 19TH AVE SE
Practice Address - Street 2:B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4280
Practice Address - Country:US
Practice Address - Phone:408-570-0510
Practice Address - Fax:408-945-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty