Healthcare Provider Details

I. General information

NPI: 1790766061
Provider Name (Legal Business Name): SUMMIT REHABILITATION AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

294 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-6003
  • Fax: 816-554-6013
Mailing address:
  • Phone: 816-554-6003
  • Fax: 816-554-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JANE BURNETT
Title or Position: OWNER
Credential: PT
Phone: 816-554-6003