Provider Demographics
NPI:1770014409
Name:SUMMIT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-957-1491
Mailing Address - Street 1:1306 MACON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2652
Mailing Address - Country:US
Mailing Address - Phone:478-987-4600
Mailing Address - Fax:844-308-4986
Practice Address - Street 1:1306 MACON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2652
Practice Address - Country:US
Practice Address - Phone:478-987-4600
Practice Address - Fax:844-308-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16106467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty