=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518235084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUMMIT KIDS PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2011
-----------------------------------------------------
Last Update Date | 12/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5880 LASSO PL
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-201-9333
-----------------------------------------------------
Fax | 720-255-2099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5880 LASSO PL
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80134-5221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-201-9333
-----------------------------------------------------
Fax | 720-255-2099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | ANN RIPLEY
-----------------------------------------------------
Credential | M.S., P.T.
-----------------------------------------------------
Telephone | 949-201-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 11002
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------