Provider Demographics
NPI:1336855691
Name:SUMMERS, KATHLEEN MARIE (CPTA/ EX PHYSIOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:CPTA/ EX PHYSIOLOGY
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPTA
Mailing Address - Street 1:2200 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist