Provider Demographics
NPI:1710257332
Name:SUMMIT PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-699-2955
Mailing Address - Street 1:6464 SW BORLAND ROAD
Mailing Address - Street 2:SUITE B5
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8876
Mailing Address - Country:US
Mailing Address - Phone:503-699-2955
Mailing Address - Fax:503-699-2703
Practice Address - Street 1:6464 SW BORLAND ROAD
Practice Address - Street 2:SUITE B5
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:503-699-2955
Practice Address - Fax:503-699-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty