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General NPI Number Information
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NPI Number | 1396480190
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Entity Type | Organization
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Legal Business Name | SUMMIT NEURODIAGNOSTICS, LLC
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 2414 BOWIE LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-8025
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Country | US
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Telephone | 817-657-4291
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Fax |
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Provider Business Mailing Address
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Address Line | 2414 BOWIE LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-8025
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Country | US
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Telephone | 817-657-4291
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | SCOTT MCCAULEY
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Credential | DPT
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Telephone | 970-691-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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