MEDICARE: CODY RAY GINGERICH DPT

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	2251X0800X	Orthopedic Physical Therapist
2	390200000X	Student in an Organized Health Care Education/Training Program
3	225100000X	Physical Therapist	2305212173	VA

General Provider Information

NPI Number	:	1376053520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY RAY GINGERICH DPT

Provider Business Mailing Address
First Line	:	210 EDGEWOOD DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4240
Country	:	US
Telephone Number	:	937-623-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 HAMPTON AVE STE 11B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-1044
Country	:	US
Telephone Number	:	864-900-2975
Fax Number	:

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	01/24/2021

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