Provider Demographics
NPI:1609330315
Name:CUNNINGHAM, SIOBHAN GRACE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:GRACE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1010
Mailing Address - Country:US
Mailing Address - Phone:215-279-2863
Mailing Address - Fax:
Practice Address - Street 1:825 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1010
Practice Address - Country:US
Practice Address - Phone:215-279-2863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program