Provider Demographics
NPI:1629009550
Name:CUMMINGS, LEE ROGER (PTA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ROGER
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 1:3980 NEW COVINGTON PIKE
Mailing Address - Street 2:108
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2500
Mailing Address - Country:US
Mailing Address - Phone:901-937-3200
Mailing Address - Fax:901-383-1738
Practice Address - Street 1:4816 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8529
Practice Address - Country:US
Practice Address - Phone:901-522-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant