Healthcare Provider Details

I. General information

NPI: 1932219722
Provider Name (Legal Business Name): JOHN CHARLES CUMMINGS LMT MMP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SAN MATCO BLVD NE SUITE F
ALBUQUERQUE NM
87110-3163
US

IV. Provider business mailing address

2620 SAN MATCO BLVD NE SUITE F
ALBUQUERQUE NM
87110-3163
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-4044
  • Fax: 505-888-1932
Mailing address:
  • Phone: 505-888-4044
  • Fax: 505-888-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNM4767
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: