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NPI Code Detail

MEDICARE: LAURA JEAN CUNNINGHAM DPT

MEDICARE: LAURA JEAN CUNNINGHAM DPT
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
1225100000XPhysical Therapist27786FL

Other Identifiers

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

General Provider Information

NPI Number : 1548558091
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA JEAN CUNNINGHAM DPT
Provider Business Mailing Address
First Line : 3416 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33629-8639
Country : US
Telephone Number : 813-837-3060
Fax Number : 813-837-3080
Provider Business Practice Location Address
First Line : 3416 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33629-8639
Country : US
Telephone Number : 813-837-3060
Fax Number : 813-837-3080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 01/28/2013

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