Provider Demographics
NPI:1073288635
Name:CUNNINGHAM, ALEAH R
Entity Type:Individual
Prefix:
First Name:ALEAH
Middle Name:R
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16077 E 1485TH AVE
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-3403
Mailing Address - Country:US
Mailing Address - Phone:217-690-5068
Mailing Address - Fax:
Practice Address - Street 1:16077 E 1485TH AVE
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-3403
Practice Address - Country:US
Practice Address - Phone:217-690-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant