Provider Demographics
NPI:1053194217
Name:CUNNINGHAM, NOAH BRAYDEN (DPT)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:BRAYDEN
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:SLAUGHTERS
Mailing Address - State:KY
Mailing Address - Zip Code:42456-9623
Mailing Address - Country:US
Mailing Address - Phone:270-836-5122
Mailing Address - Fax:
Practice Address - Street 1:10 W NIFONG BLVD STE 121
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6006
Practice Address - Country:US
Practice Address - Phone:573-442-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist