Basic Information
| Provider Information | |||||||||
| NPI: | 1558662940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT REHABILITATION, PLLC | ||||||||
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| OtherOrganizationName: | FALCON PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 116TH AVE NE | ||||||||
| Address2: | 101 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255027145 | ||||||||
| FaxNumber: | 4255027320 | ||||||||
| Practice Location | |||||||||
| Address1: | 10505 19TH AVE SE | ||||||||
| Address2: | B | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982084280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085700510 | ||||||||
| FaxNumber: | 4089454018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2010 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | PACE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2138041712 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.