Provider Demographics
NPI:1619477114
Name:CUMMINGS, BONNIE RAE (PTA)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:RAE
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 1:1070 N FOREST VIEW DR N
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1082
Mailing Address - Country:US
Mailing Address - Phone:765-212-4449
Mailing Address - Fax:
Practice Address - Street 1:3211 E MOORES PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-7129
Practice Address - Country:US
Practice Address - Phone:812-334-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002272A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant