Provider Demographics
NPI:1881187243
Name:CUMMINS, DANIEL JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:CUMMINS
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0220
Mailing Address - Country:US
Mailing Address - Phone:708-590-6663
Mailing Address - Fax:
Practice Address - Street 1:602 S NEIL ST STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5765
Practice Address - Country:US
Practice Address - Phone:217-649-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1063868206OtherGROUP NPI NUMBER