MEDICARE: ALICIA E CUNNINGHAM DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4689	NM

General Provider Information

NPI Number	:	1225529936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA E CUNNINGHAM DPT

Provider Business Mailing Address
First Line	:	1501 SAN PEDRO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-265-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 LA PLAZA DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-2813
Country	:	US
Telephone Number	:	505-615-0825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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Directions to “ ALICIA E CUNNINGHAM DPT” Practice Location

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