Provider Demographics
NPI:1306176573
Name:CUNNINGHAM, KARA (PT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1835
Mailing Address - Country:US
Mailing Address - Phone:605-692-5351
Mailing Address - Fax:605-692-3556
Practice Address - Street 1:405 1ST AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1835
Practice Address - Country:US
Practice Address - Phone:605-692-5351
Practice Address - Fax:605-692-3556
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist