Healthcare Provider Details

I. General information

NPI: 1912918079
Provider Name (Legal Business Name): SUMMIT PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 PENCO RD
WEIRTON WV
26062
US

IV. Provider business mailing address

414 PENCO RD
WEIRTON WV
26062
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 W MASCIO
Title or Position: VP
Credential: LPT
Phone: 304-723-3780