Basic Information
| Provider Information | |||||||||
| NPI: | 1861007478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39350 CIVIC CENTER DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Practice Location | |||||||||
| Address1: | 39350 CIVIC CENTER DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2020 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 299092 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT299092 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.