Healthcare Provider Details

I. General information

NPI: 1811227093
Provider Name (Legal Business Name): SUMMIT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 N 16TH ST STE 100
PHOENIX AZ
85020-5259
US

IV. Provider business mailing address

7310 N 16TH ST STE 100
PHOENIX AZ
85020-5258
US

V. Phone/Fax

Practice location:
  • Phone: 602-535-8255
  • Fax: 602-535-8254
Mailing address:
  • Phone: 602-535-8255
  • Fax: 602-535-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREW LENICK
Title or Position: PRESIDENT / ADMINISTRATOR
Credential:
Phone: 602-535-8255