Healthcare Provider Details

I. General information

NPI: 1760374771
Provider Name (Legal Business Name): SUMMIT REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 19TH AVE SE STE B
EVERETT WA
98208-4279
US

IV. Provider business mailing address

2600 DALLAS PKWY STE 290
FRISCO TX
75034-7493
US

V. Phone/Fax

Practice location:
  • Phone: 425-372-7092
  • Fax:
Mailing address:
  • Phone: 945-260-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS POAN
Title or Position: CFO
Credential:
Phone: 714-402-0829