Provider Demographics
NPI:1891877965
Name:CUMMINGS, KEVIN G (MSA PT OCS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:CUMMINGS
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Gender:M
Credentials:MSA PT OCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:192 TILLEY DR
Mailing Address - Street 2:MAILSTOP 438OC1
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4440
Mailing Address - Country:US
Mailing Address - Phone:802-847-7011
Mailing Address - Fax:802-847-6987
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:MAILSTOP 438OC1
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-7011
Practice Address - Fax:802-847-6987
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT41110210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist