Individual
MRS. SUMMER MACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
360 COUNTY ROAD 122, HESPERUS, CO 81326-9447
(575) 639-0778
Mailing address
360 COUNTY ROAD 122, HESPERUS, CO 81326-9447
(575) 639-0778
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0013409
CO
Other
Enumeration date
07/27/2014
Last updated
07/27/2014
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