Provider Demographics
NPI:1467584771
Name:CUMMINGS, DUSTIN TORREY (PTA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:TORREY
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 S STREAM RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-8710
Mailing Address - Country:US
Mailing Address - Phone:802-779-5482
Mailing Address - Fax:
Practice Address - Street 1:YUMA REAHABILITION HOSPITAL
Practice Address - Street 2:901 WEST 24TH STREET
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367
Practice Address - Country:US
Practice Address - Phone:802-779-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0410000496225200000X
MA8114225200000X
WYPTA527225200000X
AZ7096A225200000X
MT1944PTA225200000X
IDPTA2099225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant