Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PHYP2120 | AK |
NPI | 1770601387 |
---|---|
Provider Name | Mark E Cunningham |
First Address | Soldotna, AK 99669-7623 |
Second Address | Soldotna, AK 99669-7623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 11/06/2017 |