Healthcare Provider Details

I. General information

NPI: 1013648153
Provider Name (Legal Business Name): SUMMIT REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 4TH ST NE UNIT 101
LAKE STEVENS WA
98258-1937
US

IV. Provider business mailing address

2035 CORTE DEL NOGAL STE 200
CARLSBAD CA
92011-1445
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-1514
  • Fax: 206-743-9143
Mailing address:
  • Phone: 760-931-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PACE
Title or Position: OWNER
Credential:
Phone: 213-804-1712