Provider Demographics
NPI:1508304403
Name:SUMMIT PEDIATRIC THERAPY CORP
Entity type:Organization
Organization Name:SUMMIT PEDIATRIC THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:I
Authorized Official - Last Name:HENDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-607-5333
Mailing Address - Street 1:204 NE CHIPMAN RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2404
Mailing Address - Country:US
Mailing Address - Phone:816-607-5333
Mailing Address - Fax:
Practice Address - Street 1:204 NE CHIPMAN RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2404
Practice Address - Country:US
Practice Address - Phone:816-607-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare