Provider Demographics
NPI:1174231732
Name:CUNNINGHAM, ALYX (PTA)
Entity type:Individual
Prefix:
First Name:ALYX
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6142
Mailing Address - Country:US
Mailing Address - Phone:979-418-7165
Mailing Address - Fax:800-519-5153
Practice Address - Street 1:309 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6142
Practice Address - Country:US
Practice Address - Phone:979-418-7165
Practice Address - Fax:800-519-5153
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2173263225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant