Provider Demographics
NPI:1851820104
Name:LAND, SUMMER NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:NICOLE
Last Name:LAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:NICOLE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2740 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6141
Mailing Address - Country:US
Mailing Address - Phone:501-329-5459
Mailing Address - Fax:501-327-1738
Practice Address - Street 1:301 N SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4383
Practice Address - Country:US
Practice Address - Phone:479-890-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant