Provider Demographics
NPI:1679926513
Name:SUMMIT PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIROUX
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:810-922-4646
Mailing Address - Street 1:72 S WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6421
Mailing Address - Country:US
Mailing Address - Phone:248-460-1572
Mailing Address - Fax:248-460-1573
Practice Address - Street 1:72 S WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6421
Practice Address - Country:US
Practice Address - Phone:248-460-1572
Practice Address - Fax:248-460-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty