Provider Demographics
NPI:1871560524
Name:CUNNANE, JOSEPH WILLIAM (ATC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:CUNNANE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 SEQUOIA WAY
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-6322
Mailing Address - Country:US
Mailing Address - Phone:815-588-8416
Mailing Address - Fax:
Practice Address - Street 1:1333 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3823
Practice Address - Country:US
Practice Address - Phone:815-588-8416
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2255A2300XMedicare UPIN