Provider Demographics
NPI:1740282052
Name:SUMMIT PHYSICAL THERAPY P A
Entity type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:NIEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-732-7797
Mailing Address - Street 1:5212 VILLAGE CREEK DR STE B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5066
Mailing Address - Country:US
Mailing Address - Phone:972-732-7797
Mailing Address - Fax:972-732-7794
Practice Address - Street 1:5212 VILLAGE CREEK DR STE B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5066
Practice Address - Country:US
Practice Address - Phone:972-732-7797
Practice Address - Fax:972-732-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX602190000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00609TMedicare PIN