Healthcare Provider Details

I. General information

NPI: 1609925072
Provider Name (Legal Business Name): JAMES ALLEN CUNNINGHAM P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 S AUBURN ST
GRASS VALLEY CA
95945-7222
US

IV. Provider business mailing address

518 S AUBURN ST
GRASS VALLEY CA
95945-7222
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-3936
  • Fax: 530-277-3936
Mailing address:
  • Phone: 530-277-3936
  • Fax: 530-277-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT77997
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT11714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: