Provider Demographics
NPI:1699428755
Name:CUNNINGHAM, NATHANIEL TODD (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:TODD
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:619 N HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2117
Mailing Address - Country:US
Mailing Address - Phone:423-200-7751
Mailing Address - Fax:
Practice Address - Street 1:427 HIGHWAY 53 E UNIT 250
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3058
Practice Address - Country:US
Practice Address - Phone:706-403-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014722225100000X
TN12788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist