Provider Demographics
NPI:1245621515
Name:CUNNINGHAM, JAIMIE M (DPT)
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:M
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 1:66-059 ALAPII STREET
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1502
Mailing Address - Country:US
Mailing Address - Phone:574-527-2386
Mailing Address - Fax:801-495-5303
Practice Address - Street 1:59-794 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE A1
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9424
Practice Address - Country:US
Practice Address - Phone:808-224-5860
Practice Address - Fax:808-356-1719
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
HIPT3967208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist