1841312170 NPI number — MRS. DIANE PEARL CUMMINGS PHYSICAL THERAPY AS

Table of content: MRS. DIANE PEARL CUMMINGS PHYSICAL THERAPY AS (NPI 1841312170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841312170 NPI number — MRS. DIANE PEARL CUMMINGS PHYSICAL THERAPY AS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMMINGS
Provider First Name:
DIANE
Provider Middle Name:
PEARL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPY AS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
DIANE
Provider Other Middle Name:
PEARL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841312170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4560 SE INTERNATIONAL WAY
Provider Second Line Business Mailing Address:
SUITE 100 CONSONUS HEALTHCARE SERVICES
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-206-5129
Provider Business Mailing Address Fax Number:
971-206-5209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 MONTGOMERY DR
Provider Second Line Business Practice Location Address:
SPRING LAKE VILLAGE SKILLED NURSING FACILITY
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-579-6972
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007

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: 225200000X , with the licence number:  AT396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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