Healthcare Provider Details

I. General information

NPI: 1639171507
Provider Name (Legal Business Name): DAVID ALAN MCCUNE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2359 N TRIPHAMMER RD SUITE 5
ITHACA NY
14850-1059
US

IV. Provider business mailing address

2359 N TRIPHAMMER RD SUITE 5
ITHACA NY
14850-1059
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-5009
  • Fax: 607-257-9985
Mailing address:
  • Phone: 607-257-5009
  • Fax: 607-257-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number007082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: