Individual
STEPHEN L. SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4301 MACCORKLE AVE S.E., CHARLESTON, WV 25304
(304) 720-9185
(304) 720-9186
Mailing address
415 MORRIS ST STE 400, CHARLESTON, WV 25301-1854
(304) 343-4583
(304) 343-9207
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
000879
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217253
ANTHEM BCBS
—
01
—
001720895
MOUNTAIN STATE BCBS
—
05
—
0157001000
—
WV
01
—
650019724
RR MEDICARE
—
Enumeration date
07/19/2006
Last updated
09/02/2020
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