Provider Demographics
NPI:1932219722
Name:CUMMINGS, JOHN CHARLES (LMT MMP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2620 SAN MATCO BLVD NE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3163
Mailing Address - Country:US
Mailing Address - Phone:505-888-4044
Mailing Address - Fax:505-888-1932
Practice Address - Street 1:2620 SAN MATCO BLVD NE
Practice Address - Street 2:SUITE F
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3163
Practice Address - Country:US
Practice Address - Phone:505-888-4044
Practice Address - Fax:505-888-1932
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM4767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00RM06OtherBCBS