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General NPI Number Information
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NPI Number | 1861979445
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Entity Type | Organization
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Legal Business Name | SUMMIT WELLNESS, INC.
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 301 E RESERVOIR AVE STE 1
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City | MILWAUKEE
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State | WI
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Zip | 53212-3743
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Country | US
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Telephone | 414-350-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 5154 N LYDELL AVE
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-5532
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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 | PRESIDENT
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Name | ANTHONY LANGTIMM
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Credential |
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Telephone | 414-350-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 10271-24
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License Number State | WI
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