Healthcare Provider Details

I. General information

NPI: 1982395620
Provider Name (Legal Business Name): TYLER DALE CUNNINGHAM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2009
US

IV. Provider business mailing address

212 MCFARLAND BLVD
NORTHPORT AL
35476-3326
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-759-8794
Mailing address:
  • Phone: 205-333-5351
  • Fax: 205-333-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11320
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: