Summit Sports Performance and Rehab Center, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5080663-2401 Issued in UT

Legal business name

SUMMIT SPORTS PERFORMANCE AND REHAB CENTER, PLLC

Practice address

2760 Rasmussen Rd
Suites D2-D3
Park City, UT 84098-5684

Phone

(801) 718-5378

NPI assigned

May 27, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jessica J Tidswell, PT, DPT, SCS, ATCNPI 1952593568

Title

Manager

Phone

(801) 718-5378

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica J Tidswell, PT, DPT, SCS, ATC

  • Physical Therapist
  • Park City, UT
  • NPI 1952593568
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1972915874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 RASMUSSEN RD",
            "address_2": "SUITES D2-D3",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985684",
            "telephone_number": "801-718-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 RASMUSSEN RD",
            "address_2": "SUITES D2-D3",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840985684",
            "telephone_number": "801-718-5378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT SPORTS PERFORMANCE AND REHAB CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "TIDSWELL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-718-5378",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, SCS, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "UT",
            "license": "5080663-2401",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "UT",
            "license": "5080663-4810",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tarah Rachele Stowell, L.C.S.W.
• Successware LLC
• Jessica Sullenberger
• Summit County Clubhouse
• Summit County Early Intervention
• Jeffrey Rex Sumsion, DMD, MS
• Sundance Counseling LLC
• Pamela L Sunshine, PA-C
• David Rick Sutherland, MD
• Sarah Sutin

• Physical Therapy Clinic/Center in Park City, UT
• Providers in Park City, UT by specialty
• Physical Therapy Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.