Provider Demographics
NPI:1548489750
Name:CUMMINS, LISA-ANNE (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:LISA-ANNE
Middle Name:
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 MULBERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3825
Mailing Address - Country:US
Mailing Address - Phone:706-863-6783
Mailing Address - Fax:
Practice Address - Street 1:937 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0008
Practice Address - Country:US
Practice Address - Phone:706-721-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0006802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer