=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437230141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID ALAN MCCUNE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 12/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2359 N TRIPHAMMER RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-257-5009
-----------------------------------------------------
Fax | 607-257-9985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2359 N TRIPHAMMER RD
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-257-5009
-----------------------------------------------------
Fax | 607-257-9985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MARLENE A SACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-257-5009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------