Provider Demographics
NPI:1366404931
Name:CUNNINGHAM, TRINA (M ED, ATC, MT, CFO)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:M ED, ATC, MT, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1859
Mailing Address - Country:US
Mailing Address - Phone:732-571-9111
Mailing Address - Fax:732-571-9202
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1859
Practice Address - Country:US
Practice Address - Phone:732-571-9111
Practice Address - Fax:732-571-9202
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001062002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer