Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05011794A | IN |
Y | 2251X0800X | Physical Therapist - Orthopedic | 05011794A | IN |
NPI | 1063897205 |
---|---|
Provider Name | Courtney K Summitt |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Brownsburg, IN 46112-7830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2015 |
Last Update Date | 30/01/2018 |