Individual
JACOB CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6459 US HIGHWAY 6, PORTAGE, IN 46368-5109
(219) 762-5592
(219) 762-5664
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004290A
IN
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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