Provider Demographics
NPI:1679047468
Name:SUMMIT MOBILE REHAB LLC
Entity Type:Organization
Organization Name:SUMMIT MOBILE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUCHARIA
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:ANACHEBE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:404-966-3998
Mailing Address - Street 1:200 BRIDGESTONE CV
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8199
Mailing Address - Country:US
Mailing Address - Phone:404-966-3998
Mailing Address - Fax:
Practice Address - Street 1:200 BRIDGESTONE CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-8199
Practice Address - Country:US
Practice Address - Phone:404-966-3998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health