Provider Demographics
NPI:1225430283
Name:SUMMITT, RYAN J (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:SUMMITT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 W CARMEL DR
Mailing Address - Street 2:BLDG. C
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1185 W CARMEL DR
Practice Address - Street 2:BLDG. C
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8706
Practice Address - Country:US
Practice Address - Phone:317-582-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011540A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic