MEDICARE: MR. DAVID KENNETH CUMINS MPT

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	225100000X	Physical Therapist	2305202290	VA

General Provider Information

NPI Number	:	1053594234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID KENNETH CUMINS MPT

Provider Business Mailing Address
First Line	:	3308 FRANKLIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-1310
Country	:	US
Telephone Number	:	540-985-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	3308 FRANKLIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-1310
Country	:	US
Telephone Number	:	540-985-0463
Fax Number	:

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

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/12/2007

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