Provider Demographics
NPI:1497306831
Name:CUNNINGHAM, BRITANY JENNIFER (PTA)
Entity Type:Individual
Prefix:
First Name:BRITANY
Middle Name:JENNIFER
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRITANY
Other - Middle Name:JENNIFER
Other - Last Name:PUGSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 BRAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6750
Mailing Address - Country:US
Mailing Address - Phone:208-863-2288
Mailing Address - Fax:
Practice Address - Street 1:222 E ELM ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4815
Practice Address - Country:US
Practice Address - Phone:208-459-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-6429225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant