Organization
SUMMIT PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS MARTIN (OWNER)
(304) 564-1098
Entity
Organization
Contact information
Practice address
621 N CHESTER ST, NEW CUMBERLAND, WV 26047-9604
(304) 564-1098
(304) 564-5020
Mailing address
414 PENCO RD, WEIRTON, WV 26062-3822
(304) 723-3780
(304) 723-4110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001084
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000745331
BCBS
WV
05
—
3810004835
—
WV
01
—
=========
TAX ID
WV
Enumeration date
04/18/2007
Last updated
06/20/2022
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