Healthcare Provider Details

I. General information

NPI: 1255681045
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY INCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CAROLINA AVE
CHESTER WV
26034-1111
US

IV. Provider business mailing address

414 PENCO RD
WEIRTON WV
26062-3822
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3780
  • Fax: 304-723-4110
Mailing address:
  • Phone: 304-723-3780
  • Fax: 304-723-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK MASCIO
Title or Position: PRESIDENT
Credential: PT
Phone: 304-723-3780