Provider Demographics
NPI:1811227093
Name:SUMMIT THERAPY LLC
Entity Type:Organization
Organization Name:SUMMIT THERAPY LLC
Other - Org Name:SUMMIT THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LENICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-535-8255
Mailing Address - Street 1:7310 N 16TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5258
Mailing Address - Country:US
Mailing Address - Phone:602-535-8255
Mailing Address - Fax:602-535-8254
Practice Address - Street 1:7310 N 16TH ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5259
Practice Address - Country:US
Practice Address - Phone:602-535-8255
Practice Address - Fax:602-535-8254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KCINEL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-11
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X, 261QP2000X, 261QR0400X, 261QX0100X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ137432Medicare PIN