Provider Demographics
NPI:1073691200
Name:CUMINS THERAPY & FITNESS TRAINING LLC
Entity Type:Organization
Organization Name:CUMINS THERAPY & FITNESS TRAINING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:CUMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:540-985-0463
Mailing Address - Street 1:3308 FRANKLIN ROAD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-985-0463
Mailing Address - Fax:540-985-0464
Practice Address - Street 1:3308 FRANKLIN ROAD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-985-0463
Practice Address - Fax:540-985-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202290261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00045523OtherRAILROAD MEDICARE
VA212228OtherSOUTHERN HEALTH
VA7992482OtherAENTA GROUP
7251125OtherAETNA
VA288802OtherANTHEM
VADA4505OtherRAILROAD MEDICARE GROUP
=========Medicare UPIN
VADA4505OtherRAILROAD MEDICARE GROUP
VA212228OtherSOUTHERN HEALTH