Provider Demographics
NPI:1669488656
Name:SUMMERS, KAREN MARTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARTIN
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 MATTHEW AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1145
Mailing Address - Country:US
Mailing Address - Phone:505-255-3726
Mailing Address - Fax:
Practice Address - Street 1:923 MATTHEW AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1145
Practice Address - Country:US
Practice Address - Phone:505-362-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K0101Medicaid