Provider Demographics
NPI:1023298999
Name:SUMMIT HAND THERAPY LLC
Entity type:Organization
Organization Name:SUMMIT HAND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:801-773-2633
Mailing Address - Street 1:2179 N 1700 W
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1138
Mailing Address - Country:US
Mailing Address - Phone:801-773-2633
Mailing Address - Fax:801-773-1553
Practice Address - Street 1:2179 N 1700 W
Practice Address - Street 2:SUITE 5
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1138
Practice Address - Country:US
Practice Address - Phone:801-773-2633
Practice Address - Fax:801-773-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6717526-4201225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6132300001Medicare NSC