Healthcare Provider Details

I. General information

NPI: 1225514110
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 07/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 HAMILL ROAD
HIXSON TN
37342
US

IV. Provider business mailing address

1790 HAMILL ROAD
HIXSON TN
37342
US

V. Phone/Fax

Practice location:
  • Phone: 423-842-9322
  • Fax: 866-591-0619
Mailing address:
  • Phone: 423-842-9322
  • Fax: 866-591-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
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: KEVIN KOSTKA
Title or Position: CO-OWNER,DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 423-842-9322