Provider Demographics
NPI:1548565104
Name:CUNNINGHAM, TIA GENNESSA (DPT)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:GENNESSA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 ENGLAND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2111
Mailing Address - Country:US
Mailing Address - Phone:804-798-9870
Mailing Address - Fax:804-798-1482
Practice Address - Street 1:429 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2111
Practice Address - Country:US
Practice Address - Phone:804-798-9870
Practice Address - Fax:804-798-1482
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist