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NPI Code Detail

MEDICARE: SUMMIT PHYSICAL THERAPY INCORPORATION

MEDICARE: SUMMIT PHYSICAL THERAPY INCORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1255681045
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUMMIT PHYSICAL THERAPY INCORPORATION
Provider Business Mailing Address
First Line : 414 PENCO RD
Second Line :
City : WEIRTON
State : WV
Zip : 26062-3822
Country : US
Telephone Number : 304-723-3780
Fax Number : 304-723-4110
Provider Business Practice Location Address
First Line : 118 CAROLINA AVE
Second Line :
City : CHESTER
State : WV
Zip : 26034-1111
Country : US
Telephone Number : 304-723-3780
Fax Number : 304-723-4110
Authorized Official
Title or Position : PRESIDENT
Name : MARK MASCIO
Credential : PT
Telephone Number : 304-723-3780
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/19/2012

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Directions to “SUMMIT PHYSICAL THERAPY INCORPORATION ” Practice Location

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