Provider Demographics
NPI:1619987955
Name:CUNNINGHAM, JANE (PT)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
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:P.O. BOX 1732
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-392-3700
Mailing Address - Fax:301-392-3876
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-392-3700
Practice Address - Fax:301-392-3876
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336006OtherALLIANCE
MD53485701OtherBLUE CROSS OF MARYLAND
650023076OtherRAILROAD MEDICARE
TRICAREOther521983163
DCT628 0001OtherBLUE CROSS BLUE SHIELD DC
MD147264000OtherDEPT OF LABOR
DCT628 0001OtherBLUE CROSS BLUE SHIELD DC