Organization
SUMMIT REHABILITATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON MARIE STEVENS MSPT (PHYSICAL THERAPIST/MANAGING PARTNER)
(505) 546-2555
Entity
Organization
Contact information
Practice address
722 E FLORIDA ST, DEMING, NM 88030-5310
(505) 546-2555
(505) 546-2725
Mailing address
722 E FLORIDA ST, DEMING, NM 88030-5310
(505) 546-2555
(505) 546-2725
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2570
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104461700
US DEPT OF LABOR
—
01
—
23693
LVLC
—
05
—
57831271
—
NM
01
—
73559
PRES
—
01
—
NMO1Q136
BCBS
—
01
—
P00079902
RR MEDICARE
—
Enumeration date
10/17/2005
Last updated
07/15/2010
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