Provider Demographics
NPI:1689861270
Name:SUMMIT REHABILITATION, LLC
Entity Type:Organization
Organization Name:SUMMIT REHABILITATION, LLC
Other - Org Name:LAKE STEVENS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-806-5700
Mailing Address - Street 1:11805 N CREEK PKWY S
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8803
Mailing Address - Country:US
Mailing Address - Phone:425-806-5700
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:9514 4TH ST NE
Practice Address - Street 2:STE 101
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-2327
Practice Address - Fax:425-377-0283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHFORCE PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-27
Last Update Date:2008-03-24
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
WAGAB14907Medicare PIN
WA4506830001Medicare NSC