MEDICARE: LEE ROGER CUMMINGS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3694	TN

General Provider Information

NPI Number	:	1629009550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE ROGER CUMMINGS PTA

Provider Business Mailing Address
First Line	:	3980 NEW COVINGTON PIKE
Second Line	:	108
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2500
Country	:	US
Telephone Number	:	901-937-3200
Fax Number	:	901-383-1738

Provider Business Practice Location Address
First Line	:	4816 RIVERDALE RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38141-8529
Country	:	US
Telephone Number	:	901-522-6830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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