MEDICARE: MRS. MARY E 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	40QB00110500	NJ

General Provider Information

NPI Number	:	1588731558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY E CUMMINGS PTA

Provider Business Mailing Address
First Line	:	539A CALIFORNIA AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-1401
Country	:	US
Telephone Number	:	732-458-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 ROUTE 530
Second Line	:
City	:	WHITING
State	:	NJ
Zip	:	08759-3145
Country	:	US
Telephone Number	:	732-849-2045
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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