Provider Demographics
NPI:1902493042
Name:SUMMUS REHABILITATION
Entity Type:Organization
Organization Name:SUMMUS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANDERVOORT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:503-502-4946
Mailing Address - Street 1:3301 S MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2817
Mailing Address - Country:US
Mailing Address - Phone:503-502-4946
Mailing Address - Fax:
Practice Address - Street 1:5354 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1244
Practice Address - Country:US
Practice Address - Phone:503-502-4946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty