MEDICARE: CAITLIN CODY PTA

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
1	225200000X	Physical Therapy Assistant	PTA28428	FL

General Provider Information

NPI Number	:	1164989554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN CODY PTA

Provider Business Mailing Address
First Line	:	7625 BRIARWOOD DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7625 BRIARWOOD DR
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-3273
Country	:	US
Telephone Number	:	516-592-3643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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Directions to “ CAITLIN CODY PTA” Practice Location

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