Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1056 | WA |
NPI | 1457458325 |
---|---|
Provider Name | Marylynn H Cunningham |
First Address | Vancouver, WA 98666-0648 |
Second Address | Portland, OR 97239-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |