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General NPI Number Information
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NPI Number | 1518638030
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Entity Type | Individual
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Provider Name | ALEXIS JANE SUMMERS LAT, ATC, OTC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 111 MADISON AVE STE 400
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City | MORRISTOWN
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State | NJ
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Zip | 07960-7361
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Country | US
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Telephone | 304-615-8563
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MADISON AVE STE 400
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City | MORRISTOWN
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State | NJ
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Zip | 07960-7361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001880
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License Number State | WV
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