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NPI Code Detail

MEDICARE: CODY CAMP PT

MEDICARE:   CODY  CAMP  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT-1745WY

General Provider Information

NPI Number : 1114512209
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY CAMP PT
Provider Business Mailing Address
First Line : 101 WEST CROOK STREET
Second Line :
City : MOORCROFT
State : WY
Zip : 82721-5027
Country : US
Telephone Number : 307-756-9200
Fax Number :
Provider Business Practice Location Address
First Line : 101 WEST CROOK STREET
Second Line :
City : MOORCROFT
State : WY
Zip : 82721-5027
Country : US
Telephone Number : 307-756-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2021
Last Update Date : 03/02/2021

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Directions to “ CODY CAMP PT” Practice Location

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