Healthcare Provider Details

I. General information

NPI: 1497272322
Provider Name (Legal Business Name): SUMMIT REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ROBIN ROAD
GLASTONBURY CT
06033-3202
US

IV. Provider business mailing address

140 ROBIN RD
GLASTONBURY CT
06033-3202
US

V. Phone/Fax

Practice location:
  • Phone: 860-303-8518
  • Fax:
Mailing address:
  • Phone: 860-303-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: MR. KYLE MACDONALD
Title or Position: OWNER
Credential: RPT
Phone: 860-303-8518