Provider Demographics
NPI:1831359728
Name:CUMMINGS, RICKY (PT)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BROADWAY AVE
Mailing Address - Street 2:STE. 155 B
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3302
Mailing Address - Country:US
Mailing Address - Phone:217-531-8287
Mailing Address - Fax:
Practice Address - Street 1:300 S BROADWAY AVE
Practice Address - Street 2:STE. 155 B
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3302
Practice Address - Country:US
Practice Address - Phone:217-531-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011060225100000X
IL227003120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist