Organization
SUMMIT PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL KEITH LANGLEY PT (PRESIDENT)
(208) 939-3332
Entity
Organization
Contact information
Practice address
152 N SENECA SPRINGS WAY # 110, STAR, ID 83669-6037
(208) 995-2913
(208) 995-2659
Mailing address
457 S FITNESS PL STE 100, EAGLE, ID 83616-6568
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
07/16/2024
Last updated
10/28/2024
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