Provider Demographics
NPI:1073086625
Name:SUMMERS, JASON (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GREENWAY CT STE B&C
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2326
Mailing Address - Country:US
Mailing Address - Phone:770-502-0195
Mailing Address - Fax:
Practice Address - Street 1:40 GREENWAY CT STE B&C
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2326
Practice Address - Country:US
Practice Address - Phone:770-502-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016146225100000X
GACP035365T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist