Provider Demographics
NPI:1861007478
Name:CUNNINGHAM, PAUL GENE JR (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GENE
Last Name:CUNNINGHAM
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39350 CIVIC CENTER DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-797-3933
Mailing Address - Fax:510-797-5184
Practice Address - Street 1:39350 CIVIC CENTER DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-797-3933
Practice Address - Fax:510-797-5184
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299092225100000X
CAPT299092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist