Provider Demographics
NPI:1912670365
Name:CUMMINS, LUCAS ALAN I
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:ALAN
Last Name:CUMMINS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CANAL CT
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:OH
Mailing Address - Zip Code:45157-8545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 CANAL CT
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:OH
Practice Address - Zip Code:45157-8545
Practice Address - Country:US
Practice Address - Phone:513-502-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012972225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant