Provider Demographics
NPI:1427287556
Name:CUNNINGHAM, BYRON (PT, ATC)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RAMS WAY
Mailing Address - Street 2:
Mailing Address - City:EARTH CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63045-1523
Mailing Address - Country:US
Mailing Address - Phone:314-516-8735
Mailing Address - Fax:314-515-8777
Practice Address - Street 1:1 RAMS WAY
Practice Address - Street 2:
Practice Address - City:EARTH CITY
Practice Address - State:MO
Practice Address - Zip Code:63045-1523
Practice Address - Country:US
Practice Address - Phone:314-516-8735
Practice Address - Fax:314-515-8777
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8322225100000X
MO20100186852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist