Provider Demographics
NPI:1801991989
Name:CUNNINGHAM, SUSAN KIMBERLY (PT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KIMBERLY
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:S.
Other - Middle Name:KIMBERLY
Other - Last Name:CUNNIGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2721 FAIT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3835
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:410-605-7589
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:410-605-7589
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist