Healthcare Provider Details

I. General information

NPI: 1740285808
Provider Name (Legal Business Name): SUMMER CHONG RHEE-PIZANO PT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PORTER ST STE B
SOQUEL CA
95073-2467
US

IV. Provider business mailing address

1500 PARK AVE UNIT 2
CAPITOLA CA
95010-2448
US

V. Phone/Fax

Practice location:
  • Phone: 831-239-9978
  • Fax:
Mailing address:
  • Phone: 831-239-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: