Provider Demographics
NPI:1588818074
Name:CUNTAPAY, ALEJO QUIRINO III
Entity Type:Individual
Prefix:
First Name:ALEJO
Middle Name:QUIRINO
Last Name:CUNTAPAY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CHARLESTON CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8395
Mailing Address - Country:US
Mailing Address - Phone:317-839-0466
Mailing Address - Fax:
Practice Address - Street 1:1303 CHARLESTON CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8395
Practice Address - Country:US
Practice Address - Phone:317-839-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007507A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist