1962629378 NPI number — MR. KEVIN ARTHUR CUMMINGS PHYSICAL THERAPIST

Table of content: MR. KEVIN ARTHUR CUMMINGS PHYSICAL THERAPIST (NPI 1962629378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962629378 NPI number — MR. KEVIN ARTHUR CUMMINGS PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMMINGS
Provider First Name:
KEVIN
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962629378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 BARTLETT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTHROP
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02152-2912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-846-0832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CUMMINGS PHYSICAL THERAPY
Provider Second Line Business Practice Location Address:
425 REVERE ST
Provider Business Practice Location Address City Name:
REVERE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-284-7597
Provider Business Practice Location Address Fax Number:
781-485-0303
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4442 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043295182 . This is a "FED TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com