Provider Demographics
NPI:1881673390
Name:MIMS, SUMMER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:
Last Name:MIMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2185
Mailing Address - Country:US
Mailing Address - Phone:205-342-2546
Mailing Address - Fax:205-342-2540
Practice Address - Street 1:1792 MCFARLAND BLVD N
Practice Address - Street 2:SUITE B
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2185
Practice Address - Country:US
Practice Address - Phone:205-342-2546
Practice Address - Fax:205-342-2540
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA3671225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant