Provider Demographics
NPI:1649591587
Name:CUMMINGS, KEATON BENJAMIN (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEATON
Middle Name:BENJAMIN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4622
Mailing Address - Country:US
Mailing Address - Phone:605-342-3110
Mailing Address - Fax:605-342-3120
Practice Address - Street 1:2006 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4622
Practice Address - Country:US
Practice Address - Phone:605-342-3110
Practice Address - Fax:605-342-3120
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist