Healthcare Provider Details

I. General information

NPI: 1750334793
Provider Name (Legal Business Name): SUMMIT PACIFIC REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E WESTVIEW CT
SPOKANE WA
99218-3813
US

IV. Provider business mailing address

970 5TH AVE NW SUITE 7
ISSAQUAH WA
98027-2469
US

V. Phone/Fax

Practice location:
  • Phone: 509-467-5626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN E FERGUS
Title or Position: DIRECTOR OF OPERATIONS
Credential: MSPT
Phone: 253-230-5641