Provider Demographics
NPI:1386923647
Name:MUTOMBO, SUMMER MEDLIN (PT,DPT)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:MEDLIN
Last Name:MUTOMBO
Suffix:
Gender:F
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 1:18648 MCKAY DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5723
Mailing Address - Country:US
Mailing Address - Phone:281-540-0307
Mailing Address - Fax:
Practice Address - Street 1:18648 MCKAY DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:281-540-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist