Provider Demographics
NPI:1467914572
Name:CUMMINS, TIMOTHY ALAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:CUMMINS
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 1:314 HAMBLEDON WALK
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8515
Mailing Address - Country:US
Mailing Address - Phone:334-209-5656
Mailing Address - Fax:
Practice Address - Street 1:11405 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1688
Practice Address - Country:US
Practice Address - Phone:770-814-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA7760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant