Healthcare Provider Details

I. General information

NPI: 1346522976
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILHAVEN RD
MC MURRAY PA
15317-3008
US

IV. Provider business mailing address

414 PENCO RD
WEIRTON WV
26062-3822
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3780
  • Fax: 304-723-4110
Mailing address:
  • Phone: 304-723-3780
  • Fax: 304-723-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARK MASCIO
Title or Position: PRESIDENT
Credential: LPT
Phone: 304-723-3780