Provider Demographics
NPI:1750088167
Name:SUMMIT PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:SUMMIT PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTHEROW
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:678-208-8779
Mailing Address - Street 1:3115 NIMBLEWILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-3798
Mailing Address - Country:US
Mailing Address - Phone:678-208-8779
Mailing Address - Fax:
Practice Address - Street 1:3115 NIMBLEWILL CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-3798
Practice Address - Country:US
Practice Address - Phone:770-910-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy