Provider Demographics
NPI:1811367691
Name:CUNNINGHAM, RICHARD (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
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 1:8909 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7459
Mailing Address - Country:US
Mailing Address - Phone:773-251-3658
Mailing Address - Fax:773-561-0937
Practice Address - Street 1:8909 MCCONNELL RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7459
Practice Address - Country:US
Practice Address - Phone:773-251-3658
Practice Address - Fax:773-561-0937
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0085552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.008555OtherPHYSICAL THERAPY LICENSE