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General NPI Number Information
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NPI Number | 1548708571
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Entity Type | Organization
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Legal Business Name | SUMMERS AQUATIC THERAPY & FITNESS
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 36 AMBLESIDE CT
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City | DANVILLE
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State | CA
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Zip | 94526-4303
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Country | US
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Telephone | 510-501-7663
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Fax |
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Provider Business Mailing Address
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Address Line | 36 AMBLESIDE CT
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City | DANVILLE
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State | CA
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Zip | 94526-4303
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Country | US
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Telephone | 510-501-7663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE SUMMERS
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Credential | DPT
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Telephone | 510-501-7663
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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 | PT41634
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License Number State | CA
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