1558492934 NPI number — SUMMIT REHABILITATION PLLC

Table of content: (NPI 1558492934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558492934 NPI number — SUMMIT REHABILITATION PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMMIT REHABILITATION PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558492934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2035 CORTE DEL NOGAL STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-486-6025
Provider Business Mailing Address Fax Number:
855-359-7156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9514 4TH ST NE UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE STEVENS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98258-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-397-2327
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
213-804-1712

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7120637 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7101587 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7101611 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 710585 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7101595 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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