Provider Demographics
NPI:1275749194
Name:CUMMINGS, SHARON A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 DIVISION AVE. S.
Mailing Address - Street 2:BOX 284
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0284
Mailing Address - Country:US
Mailing Address - Phone:701-265-4789
Mailing Address - Fax:
Practice Address - Street 1:313 DIVISION S.
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-0284
Practice Address - Country:US
Practice Address - Phone:701-265-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND196225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND58569Medicaid
ND196OtherND PTLICENSE #