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General NPI Number Information
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NPI Number | 1508798018
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Entity Type | Organization
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Legal Business Name | SUMMIT PERFORMANCE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/30/2026
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Last Update Date | 05/30/2026
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Provider Practice Location Address
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Address Line | 567 HANLEY INDUSTRIAL CT
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City | BRENTWOOD
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State | MO
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Zip | 63144-1901
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Country | US
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Telephone | 309-231-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E CLINTON PL
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City | SAINT LOUIS
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State | MO
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Zip | 63122-6106
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Country | US
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Telephone | 309-231-0196
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAYLOR DETTMANN
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Credential | DPT PT
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Telephone | 309-231-0196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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