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NPI Code Detail

MEDICARE: CODY WAYNE PEARSON DPT

MEDICARE: CODY WAYNE PEARSON 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
1225100000XPhysical Therapist12304520-2401UT

General Provider Information

NPI Number : 1427626076
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY WAYNE PEARSON DPT
Provider Business Mailing Address
First Line : 250 W 300 N
Second Line :
City : ROOSEVELT
State : UT
Zip : 84066-2351
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 250 W 300 N
Second Line :
City : ROOSEVELT
State : UT
Zip : 84066-2351
Country : US
Telephone Number : 435-722-6186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2021
Last Update Date : 06/10/2021

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Directions to “ CODY WAYNE PEARSON DPT” Practice Location

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