Provider Demographics
NPI:1700503208
Name:SUMMIT SPA & FLOAT - SPANISH FORK LLC
Entity Type:Organization
Organization Name:SUMMIT SPA & FLOAT - SPANISH FORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:GUBLER
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:435-660-9623
Mailing Address - Street 1:63 E 800 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1210
Mailing Address - Country:US
Mailing Address - Phone:435-660-9623
Mailing Address - Fax:
Practice Address - Street 1:63 E 800 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1210
Practice Address - Country:US
Practice Address - Phone:435-660-9623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service