Provider Demographics
NPI:1568761203
Name:SUMMIT PT, PLLC
Entity Type:Organization
Organization Name:SUMMIT PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:407-247-4454
Mailing Address - Street 1:5226 ANGELO CIR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-9024
Mailing Address - Country:US
Mailing Address - Phone:407-247-4454
Mailing Address - Fax:
Practice Address - Street 1:4141 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2131
Practice Address - Country:US
Practice Address - Phone:407-247-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891147900Medicaid