MEDICARE: SUMMIT PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT013626L	PA

General Provider Information

NPI Number	:	1558387639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	PO BOX 627
Second Line	:
City	:	POCONO SUMMIT
State	:	PA
Zip	:	18346-0627
Country	:	US
Telephone Number	:	570-839-8818
Fax Number	:	570-839-9140

Provider Business Practice Location Address
First Line	:	ROUTE 940
Second Line	:	POCONO SUMMIT PLAZA
City	:	POCONO SUMMIT
State	:	PA
Zip	:	18346-0627
Country	:	US
Telephone Number	:	570-839-8818
Fax Number	:	570-839-9140

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. JEFFERY JOSEPH SUKENICK
Credential	:	MSPT
Telephone Number	:	570-839-8818

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/24/2012

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Directions to “SUMMIT PHYSICAL THERAPY INC ” Practice Location

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