Provider Demographics
NPI:1609925072
Name:CUNNINGHAM, JAMES ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:CUNNINGHAM
Suffix:
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 1:518 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7222
Mailing Address - Country:US
Mailing Address - Phone:530-277-3936
Mailing Address - Fax:530-277-3936
Practice Address - Street 1:518 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7222
Practice Address - Country:US
Practice Address - Phone:530-277-3936
Practice Address - Fax:530-277-3936
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11714225100000X
CALMFT77997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11714OtherP.T. LICENSE
CAPT11714OtherP.T. LICENSE
CA0PT117141Medicare ID - Type Unspecified