Provider Demographics
NPI:1639171507
Name:MCCUNE, DAVID ALAN (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:MCCUNE
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 1:2359 N TRIPHAMMER RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1059
Mailing Address - Country:US
Mailing Address - Phone:607-257-5009
Mailing Address - Fax:607-257-9985
Practice Address - Street 1:2359 N TRIPHAMMER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1059
Practice Address - Country:US
Practice Address - Phone:607-257-5009
Practice Address - Fax:607-257-9985
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01052060Medicaid
NYCC6894Medicare PIN
NY01052060Medicaid