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General NPI Number Information
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NPI Number | 1881979623
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Entity Type | Individual
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Provider Name | MARIA LOUISE CUNNINGHAM LPT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 916 TALON DR SUITE 102
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City | O FALLON
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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Provider Business Mailing Address
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Address Line | 916 TALON DR SUITE 102
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City | O FALLON
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 070018731
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License Number State | IL
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