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NPI Code Detail

MEDICARE: CHRISTINA MARLENE SUMMERS

MEDICARE: CHRISTINA MARLENE SUMMERS
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
1225800000XRecreation Therapist8993761-4003UT

General Provider Information

NPI Number : 1669220372
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARLENE SUMMERS
Provider Business Mailing Address
First Line : 1481 DALLAS ST
Second Line :
City : SYRACUSE
State : UT
Zip : 84075-9405
Country : US
Telephone Number : 385-368-3992
Fax Number :
Provider Business Practice Location Address
First Line : 1481 E 1450 S
Second Line :
City : CLEARFIELD
State : UT
Zip : 84015-1610
Country : US
Telephone Number : 801-728-4326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2024
Last Update Date : 05/08/2024

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Directions to “ CHRISTINA MARLENE SUMMERS ” Practice Location

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