Provider Demographics
NPI:1679777619
Name:SUMMERS, KATHRYN ANNETTE (PTA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNETTE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANNETTE
Other - Last Name:SUMMERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:9071 E ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5361
Mailing Address - Country:US
Mailing Address - Phone:480-663-6881
Mailing Address - Fax:
Practice Address - Street 1:7540 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6047A225200000X
ARPTA1340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant