Organization
SUMMIT SPORTS PERFORMANCE AND REHAB CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA J TIDSWELL PT, DPT, SCS, ATC (MANAGER)
(801) 718-5378
Entity
Organization
Contact information
Practice address
2760 RASMUSSEN RD, SUITES D2-D3, PARK CITY, UT 84098-5684
(801) 718-5378
Mailing address
2760 RASMUSSEN RD, SUITES D2-D3, PARK CITY, UT 84098-5684
(801) 718-5378
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
5080663-2401
UT
261QP2000X
Physical Therapy Clinic/Center
5080663-4810
UT
Other
Enumeration date
05/27/2014
Last updated
05/27/2014
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