Individual provider Active NPI

Gina Marie Cunningham, PT, DPT

  • Physical Therapist
  • King of Prussia, PA
National Provider Identifier
1508106196
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT022587 Issued in PA
Practice address
120 Valley Green LN Ste 610
King of Prussia, PA 19406-2080
Phone
(484) 685-3045
Fax
(484) 685-3046
NPI assigned
Feb 19, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT022587 PA Primary

Addresses

Primary practice location

120 Valley Green LN Ste 610
King of Prussia, PA 19406-2080

Mailing address

PO Box 22581
New York, NY 10087-2581
Phone (610) 482-4795

Other identifiers 1

IdentifierTypeStateIssuer
103888224-0001MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gina.cunningham@axia.eclinicaldirectplus.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130521000272 PA Practitioner - Physical Therapist in Private Practice 5799923314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional Womens Health Group LLCGroup PAC ID 2961316328, 352 clinicians

Practice addresses (Care Compare)

120 Valley Green LN
Suite 610
King of Prussia, PA 19406-2080
Phone (484) 685-3045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT022587PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Womens Health Group LLC Physical Therapist CurrentSince Jun 21, 2021 Accepting new patients
Regional Women'S Health Group, LLC PastSince Aug 29, 2021 Accepting new patients

Locations

919 Conestoga Rd
Ste 104
Bryn Mawr, PA 19010
Phone (610) 525-6400

120 Valley Green Ln
Ste 610
King of Prussia, PA 19406
Phone (484) 685-3045

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1508106196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22581",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100872581",
            "telephone_number": "610-482-4795",
            "fax_number": "856-528-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 VALLEY GREEN LN STE 610",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062080",
            "telephone_number": "484-685-3045",
            "fax_number": "484-685-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "GINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-19",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT022587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103888224-0001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gina.cunningham@axia.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "120 Valley Green Ln Ste 610",
            "city": "King Of Prussia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "194062080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.