Provider Demographics
NPI:1629124482
Name:SUMMIT REHABILITATION
Entity Type:Organization
Organization Name:SUMMIT REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-633-3656
Mailing Address - Street 1:116 EAST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2328
Mailing Address - Country:US
Mailing Address - Phone:330-633-3656
Mailing Address - Fax:330-633-3505
Practice Address - Street 1:116 EAST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2328
Practice Address - Country:US
Practice Address - Phone:330-633-3656
Practice Address - Fax:330-633-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2244655Medicaid
OH00000168156OtherANTHEM
OH00000168156OtherANTHEM