Healthcare Provider Details

I. General information

NPI: 1982587754
Provider Name (Legal Business Name): BROOKLYN CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD STE 312
DENVER CO
80222-3335
US

IV. Provider business mailing address

5856 N TOULON DR
COEUR D ALENE ID
83815-8469
US

V. Phone/Fax

Practice location:
  • Phone: 720-479-8952
  • Fax:
Mailing address:
  • Phone: 208-277-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTL.0020635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: