=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073310918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA ROCK SUMMERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2025
-----------------------------------------------------
Last Update Date | 02/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 N STATION PKWY
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84025-2888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-791-3312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 S 4230 W
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84075-7243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-791-3312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225800000X
-----------------------------------------------------
Taxonomy Name | Recreation Therapist
-----------------------------------------------------
License Number | 108247304003
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------