Provider Demographics
NPI:1902189962
Name:CUMMINS, MELVIN CHARLES (LMT)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:CHARLES
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-9122
Mailing Address - Country:US
Mailing Address - Phone:406-223-9016
Mailing Address - Fax:
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3016
Practice Address - Country:US
Practice Address - Phone:406-223-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist