Provider Demographics
NPI:1235192816
Name:CUMMINGS, BRYAN (MSPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 W RIDGECREST AVE
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-8620
Mailing Address - Country:US
Mailing Address - Phone:509-279-0953
Mailing Address - Fax:
Practice Address - Street 1:10103 N DIVISION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1380
Practice Address - Country:US
Practice Address - Phone:509-464-0878
Practice Address - Fax:509-462-0018
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911745305-98208-B028OtherTRICARE
WA7995150OtherAETNA
WA0196802OtherDEPT. OF LABOR & INDUSTRY
WA8424913OtherDSHS
WA8424913Medicaid
WA4588CUOtherREGENCE RIDER #
WA8905656OtherL & I CRIME VICTIMS
WA4588CUOtherREGENCE RIDER #
WA8424913OtherDSHS