Healthcare Provider Details

I. General information

NPI: 1588574685
Provider Name (Legal Business Name): STEVEN MICHAEL CUNNINGHAM PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 PEACH CT UNIT 5
CHULA VISTA CA
91913-8313
US

IV. Provider business mailing address

1824 PEACH CT UNIT 5
CHULA VISTA CA
91913-8313
US

V. Phone/Fax

Practice location:
  • Phone: 619-508-0604
  • Fax:
Mailing address:
  • Phone: 619-508-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: