Provider Demographics
NPI:1770987729
Name:SUMMIT PHYSICAL THERAPY AND REHABILITATION LLC
Entity type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/LPT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:303-883-6469
Mailing Address - Street 1:12107 IDALIA ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80603-6948
Mailing Address - Country:US
Mailing Address - Phone:303-883-6469
Mailing Address - Fax:
Practice Address - Street 1:1295 E BRIDGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2277
Practice Address - Country:US
Practice Address - Phone:303-883-6469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67209068Medicaid