Provider Demographics
NPI:1629198734
Name:SUMMIT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCIOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-598-9009
Mailing Address - Street 1:60 MORRIS TPKE STE 2W
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-5007
Mailing Address - Country:US
Mailing Address - Phone:908-598-9009
Mailing Address - Fax:973-218-9717
Practice Address - Street 1:60 MORRIS TPKE STE 2W
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-5007
Practice Address - Country:US
Practice Address - Phone:908-598-9009
Practice Address - Fax:973-218-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2018-05-10
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
NJ025248Medicare ID - Type Unspecified