Provider Demographics
NPI:1497397541
Name:CUMMINGS, SANDRA CHERISE (PTA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHERISE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5914
Mailing Address - Country:US
Mailing Address - Phone:907-729-6667
Mailing Address - Fax:
Practice Address - Street 1:4201 TUDOR CENTRE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5914
Practice Address - Country:US
Practice Address - Phone:907-729-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK225200000X
AK116807225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty