Provider Demographics
NPI:1821753831
Name:SUMMIT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:802-598-7401
Mailing Address - Street 1:332 FITZGERALD RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8912
Mailing Address - Country:US
Mailing Address - Phone:802-598-7401
Mailing Address - Fax:
Practice Address - Street 1:512 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-5104
Practice Address - Country:US
Practice Address - Phone:802-328-8217
Practice Address - Fax:802-735-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty