MEDICARE: BROOKLYN CUNNINGHAM

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	2251P0200X	Pediatric Physical Therapist	PTL.0020635	CO

General Provider Information

NPI Number	:	1982587754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN CUNNINGHAM

Provider Business Mailing Address
First Line	:	5856 N TOULON DR
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-8469
Country	:	US
Telephone Number	:	208-277-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 S COLORADO BLVD STE 312
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-3335
Country	:	US
Telephone Number	:	720-479-8952
Fax Number	:

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “ BROOKLYN CUNNINGHAM ” Practice Location

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