Provider Demographics
NPI:1720395403
Name:CUMMINGS, CAROL L (CPTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2200 SUMMERLON CIR
Mailing Address - Street 2:STE D
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2900
Mailing Address - Country:US
Mailing Address - Phone:620-225-4139
Mailing Address - Fax:620-225-4286
Practice Address - Street 1:2200 SUMMERLON CIR
Practice Address - Street 2:STE D
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2900
Practice Address - Country:US
Practice Address - Phone:620-225-4139
Practice Address - Fax:620-225-4286
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-00196225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant