Healthcare Provider Details

I. General information

NPI: 1467584771
Provider Name (Legal Business Name): DUSTIN TORREY CUMMINGS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YUMA REAHABILITION HOSPITAL 901 WEST 24TH STREET
YUMA AZ
85367
US

IV. Provider business mailing address

1763 S STREAM RD
BENNINGTON VT
05201-8710
US

V. Phone/Fax

Practice location:
  • Phone: 802-779-5482
  • Fax:
Mailing address:
  • Phone: 802-779-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0410000496
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8114
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA527
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7096A
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1944PTA
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2099
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: