Provider Demographics
NPI:1396065074
Name:CUNNINGHAM, ROSE WILLOW (PT)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:WILLOW
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3656
Mailing Address - Country:US
Mailing Address - Phone:505-242-2294
Mailing Address - Fax:505-242-2917
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2681
Practice Address - Country:US
Practice Address - Phone:505-312-7930
Practice Address - Fax:505-717-2818
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist