Healthcare Provider Details

I. General information

NPI: 1487490850
Provider Name (Legal Business Name): SUMMIT NEUROREHABILITATION AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 38TH ST NW APT 725
WASHINGTON DC
20016-3044
US

IV. Provider business mailing address

919 W 34TH STREET #50278 SMB #65067
BALTIMORE MD
21211
US

V. Phone/Fax

Practice location:
  • Phone: 410-924-9503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY C MILLER
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT, NCS, CSCS
Phone: 410-924-9503