Healthcare Provider Details

I. General information

NPI: 1578877627
Provider Name (Legal Business Name): SUMMER LEE HAVILAND DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUMMER LEE WILKERSON DPT

II. Dates (important events)

Enumeration Date: 07/31/2010
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 SHALLOWFORD RD STE 102
CHATTANOOGA TN
37421-6722
US

IV. Provider business mailing address

7003 SHALLOWFORD RD STE 102
CHATTANOOGA TN
37421-6722
US

V. Phone/Fax

Practice location:
  • Phone: 423-888-6238
  • Fax: 423-220-8238
Mailing address:
  • Phone: 423-888-6238
  • Fax: 423-220-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15153
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: