Provider Demographics
NPI:1033899281
Name:SUMMIT PHYSIO & PERFORMANCE, LLC
Entity type:Organization
Organization Name:SUMMIT PHYSIO & PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:262-224-9532
Mailing Address - Street 1:4915 DRY STONE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5165
Mailing Address - Country:US
Mailing Address - Phone:262-224-9532
Mailing Address - Fax:
Practice Address - Street 1:6150 STADIA CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-2657
Practice Address - Country:US
Practice Address - Phone:719-642-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty