Provider Demographics
NPI:1962629378
Name:CUMMINGS, KEVIN ARTHUR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2912
Mailing Address - Country:US
Mailing Address - Phone:617-846-0832
Mailing Address - Fax:
Practice Address - Street 1:CUMMINGS PHYSICAL THERAPY
Practice Address - Street 2:425 REVERE ST
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151
Practice Address - Country:US
Practice Address - Phone:781-284-7597
Practice Address - Fax:781-485-0303
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043295182OtherFED TAX ID