Provider Demographics
NPI:1770601387
Name:CUNNINGHAM, MARK E (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
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 1:35249 KENAI SPUR HWY
Mailing Address - Street 2:STE C
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7623
Mailing Address - Country:US
Mailing Address - Phone:907-420-0836
Mailing Address - Fax:907-420-0837
Practice Address - Street 1:35249 KENAI SPUR HWY
Practice Address - Street 2:STE C
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7623
Practice Address - Country:US
Practice Address - Phone:541-913-3089
Practice Address - Fax:541-726-5515
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP21202251N0400X
OR35002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics