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General NPI Number Information
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NPI Number | 1023104916
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Entity Type | Individual
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Provider Name | LAURIE ELIZABETH CUNNINGHAM PT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3750 OLD LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-1806
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Country | US
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Telephone | 703-246-7184
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Fax | 703-246-7307
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Provider Business Mailing Address
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Address Line | 6063 GIANT OAK CT
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City | CENTREVILLE
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State | VA
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Zip | 20121-3054
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Country | US
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Telephone | 703-988-0285
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Fax | 703-246-7307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0105004393
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License Number State | VA
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