Provider Demographics
NPI:1801083274
Name:SUMMIT REHABILITATION, LLC
Entity type:Organization
Organization Name:SUMMIT REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-806-5700
Mailing Address - Street 1:11805 N CREEK PKWY S
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-8803
Mailing Address - Country:US
Mailing Address - Phone:425-806-5700
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:507 STATE ROUTE 2
Practice Address - Street 2:STE E
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294
Practice Address - Country:US
Practice Address - Phone:360-799-0958
Practice Address - Fax:360-799-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB14907Medicare PIN
WA4506830005Medicare NSC