Provider Demographics
NPI:1841202090
Name:CUMMINGS, KATHERYN A (PT)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NW BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1172
Mailing Address - Country:US
Mailing Address - Phone:816-587-1307
Mailing Address - Fax:
Practice Address - Street 1:6246 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2472
Practice Address - Country:US
Practice Address - Phone:816-587-6234
Practice Address - Fax:816-587-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19953042OtherBCBS PROVIDER #
MOJ63C013AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
MOP67051Medicare UPIN
MOJ63C013BMedicare ID - Type UnspecifiedMEDICARE PART B #