Provider Demographics
NPI:1568492189
Name:CUNDIFF, THOMAS JACKSON JR (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JACKSON
Last Name:CUNDIFF
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 AKERS FARM RD STE B
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4867
Practice Address - Country:US
Practice Address - Phone:540-773-2656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA101298083OtherVIRGINIA PREMIER
VAP00327765OtherRAILROAD MEDICARE
VA650020272OtherRAILROAD MEDICARE
VA5393074OtherAETNA
VA010298083Medicaid
VA266732OtherMAMSI