Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT025377 | PA |
NPI | 1164058301 |
---|---|
Provider Name | Dr. Kyle Anthony Cunningham |
First Address | Philadelphia, PA 19146-4665 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 19/03/2020 |