Healthcare Provider Details

I. General information

NPI: 1003032053
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N CHESTER ST
NEW CUMBERLAND WV
26047-9604
US

IV. Provider business mailing address

414 PENCO RD
WEIRTON WV
26062-3822
US

V. Phone/Fax

Practice location:
  • Phone: 304-564-1098
  • Fax: 304-564-5020
Mailing address:
  • Phone: 304-723-3780
  • Fax: 304-723-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001084
License Number StateWV

VIII. Authorized Official

Name: NICHOLAS MARTIN
Title or Position: OWNER
Credential:
Phone: 304-564-1098