MEDICARE: MR. CURTIS MATTHEW CUNNINGHAM PT

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	18495	MD

General Provider Information

NPI Number	:	1427071372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CURTIS MATTHEW CUNNINGHAM PT

Provider Business Mailing Address
First Line	:	5530 PHELPS LUCK DR
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2554
Country	:	US
Telephone Number	:	410-992-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	8186 LARK BROWN RD
Second Line	:	SUITE 302
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6433
Country	:	US
Telephone Number	:	410-799-4232
Fax Number	:	410-799-1811

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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