Provider Demographics
NPI:1235613647
Name:CUMMINS, CALEB RONALD (DPT)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:RONALD
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325-0296
Mailing Address - Country:US
Mailing Address - Phone:315-405-5795
Mailing Address - Fax:
Practice Address - Street 1:5686 NE MINDER RD STE 104
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-5809
Practice Address - Country:US
Practice Address - Phone:315-405-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60836665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist