Basic Information
| Provider Information | |||||||||
| NPI: | 1508453705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | MAREE | ||||||||
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| Credential: | MS,LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3722 MAYFAIR ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152041010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127265532 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 S WATER ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8559377678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2020 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | RT007095 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.