MEDICARE: SUMMIT THERAPEUTIC CONCEPTS OF PLANO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2251X0800X	Orthopedic Physical Therapist
2	2251S0007X	Sports Physical Therapist
3	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0077RK	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1467625970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT THERAPEUTIC CONCEPTS OF PLANO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 660046
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0046
Country	:	US
Telephone Number	:	214-369-8555
Fax Number	:	214-369-2683

Provider Business Practice Location Address
First Line	:	1400 PRESTON RD
Second Line	:	SUITE 250
City	:	PLANO
State	:	TX
Zip	:	75093-5186
Country	:	US
Telephone Number	:	972-596-4800
Fax Number	:	972-596-4822

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. STEVEN COLE
Credential	:	PT
Telephone Number	:	972-596-4800

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	10/29/2008

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