Healthcare Provider Details

I. General information

NPI: 1760317218
Provider Name (Legal Business Name): KEEGAN JAMES CUNNINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WARRINGTON AVE
DANVILLE IL
61832-5446
US

IV. Provider business mailing address

6919 N 100 W
CAYUGA IN
47928-8033
US

V. Phone/Fax

Practice location:
  • Phone: 217-446-0660
  • Fax:
Mailing address:
  • Phone: 217-800-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: