MEDICARE: PHILIP CUNHA DPT, PT

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	24225	MA
2	225100000X	Physical Therapist	35954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528627940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP CUNHA DPT, PT

Provider Business Mailing Address
First Line	:	4649 CLYDE MORRIS BLVD UNIT 607
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3003
Country	:	US
Telephone Number	:	386-256-3860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4649 CLYDE MORRIS BLVD UNIT 607
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3003
Country	:	US
Telephone Number	:	386-256-3860
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	08/13/2020

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