Provider Demographics
NPI:1740285808
Name:RHEE-PIZANO, SUMMER CHONG (PT, LAC)
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:CHONG
Last Name:RHEE-PIZANO
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PARK AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2448
Mailing Address - Country:US
Mailing Address - Phone:831-239-9978
Mailing Address - Fax:
Practice Address - Street 1:2825 PORTER ST STE B
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2467
Practice Address - Country:US
Practice Address - Phone:831-239-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20648225100000X
CAAC9296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT206481OtherBLUE SHIELD
CA0092960OtherBLUE SHIELD
CAOPT206480OtherBLUE SHIELD PROVIDER NUMB
CACA0092961OtherBLUE SHIELD
CA0092960OtherBLUE SHIELD