Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 070008430 | IL |
NPI | 1316185168 |
---|---|
Provider Name | Dr. Brian Cunningham |
First Address | Glenview, IL 60025-3262 |
Second Address | Glenview, IL 60025-3262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 02/02/2009 |