Provider Demographics
NPI:1922148600
Name:SUMMERLY, LINDA A (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:SUMMERLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:ZONYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:697 WILLETT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2642
Mailing Address - Country:US
Mailing Address - Phone:401-339-6560
Mailing Address - Fax:
Practice Address - Street 1:697 WILLETT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2642
Practice Address - Country:US
Practice Address - Phone:401-339-6560
Practice Address - Fax:401-247-0507
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT00877OtherSTATE LICENSE NUMBER