Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2011006548 | MO |
NPI | 1003105974 |
---|---|
Provider Name | Mrs. Clare N Cunningham |
First Address | Cape Girardeau, MO 63701 |
Second Address | Cape Girardeau, MO 63701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2011 |
Last Update Date | 11/07/2011 |