Healthcare Provider Details

I. General information

NPI: 1639390834
Provider Name (Legal Business Name): SUMMIT THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 AVENUE H
ELY NV
89301-2615
US

IV. Provider business mailing address

PO BOX 151674
ELY NV
89315-1208
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3467
  • Fax:
Mailing address:
  • Phone: 775-289-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberLLC2435-2002
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberLLC2435-2002
License Number StateNV

VIII. Authorized Official

Name: MR. VINCENT K WINDOUS
Title or Position: CO-OWNER
Credential: MPT
Phone: 775-289-3467