Provider Demographics
NPI:1891830840
Name:CUNNINGHAM, SHALA C (DPT)
Entity Type:Individual
Prefix:
First Name:SHALA
Middle Name:C
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47705-0717
Mailing Address - Country:US
Mailing Address - Phone:812-471-1591
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:8211 BELL OAKS DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2532
Practice Address - Country:US
Practice Address - Phone:812-858-8903
Practice Address - Fax:812-858-8905
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007029A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist