Basic Information
| Provider Information | |||||||||
| NPI: | 1003415548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBINANA CUNNINGHAM | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | MIGUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3530 W UNIVERSITY DR # 201 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750712931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729796577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2020 | ||||||||
| LastUpdateDate: | 10/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1218452 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.