Healthcare Provider Details

I. General information

NPI: 1063708246
Provider Name (Legal Business Name): CUNNINGHAM PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 06/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CROOKED GULLEY CIR
SUNSET BEACH NC
28468-4452
US

IV. Provider business mailing address

219 CROOKED GULLEY CIR
SUNSET BEACH NC
28468-4452
US

V. Phone/Fax

Practice location:
  • Phone: 910-880-4963
  • Fax: 910-579-9728
Mailing address:
  • Phone: 910-880-4963
  • Fax: 910-579-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11594
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BARBARA CUNNINGHAM
Title or Position: OWNER
Credential: PT
Phone: 910-880-4963