Provider Demographics
NPI:1487640769
Name:CUMMINGS, BRADLEY J (PT,CHT)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:J
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RADIO PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2998
Mailing Address - Country:US
Mailing Address - Phone:859-625-5986
Mailing Address - Fax:859-625-5987
Practice Address - Street 1:350 RADIO PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2998
Practice Address - Country:US
Practice Address - Phone:859-625-5986
Practice Address - Fax:859-625-5987
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004054225100000X
KYPT-0040542251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0718411Medicare PIN