Provider Demographics
NPI:1659322964
Name:SUMMIT SPORTS & SPINAL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SUMMIT SPORTS & SPINAL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIERAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:914-834-5490
Mailing Address - Street 1:5 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6725
Mailing Address - Country:US
Mailing Address - Phone:914-834-5490
Mailing Address - Fax:914-834-5402
Practice Address - Street 1:1420 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3922
Practice Address - Country:US
Practice Address - Phone:914-834-5490
Practice Address - Fax:914-834-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17658261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy