Provider Demographics
NPI:1336625383
Name:CUMMINS, HEIDI MARIE (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:CUMMINS
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-0037
Mailing Address - Country:US
Mailing Address - Phone:309-838-9667
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLLEGE AVE APT 220
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3171
Practice Address - Country:US
Practice Address - Phone:773-284-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist