Provider Demographics
NPI:1801246483
Name:CUMMINS, ANNABELLE
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:
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 441146
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9522
Mailing Address - Country:US
Mailing Address - Phone:770-917-1395
Mailing Address - Fax:770-423-3369
Practice Address - Street 1:249 MACK BAYOU LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7198
Practice Address - Country:US
Practice Address - Phone:770-917-1395
Practice Address - Fax:770-423-3369
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31495225100000X
OK5107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist