Healthcare Provider Details

I. General information

NPI: 1538713185
Provider Name (Legal Business Name): CODY VECCHIO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 W BASELINE RD STE 101
LAVEEN AZ
85339-2943
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 623-219-4600
  • Fax: 623-219-4601
Mailing address:
  • Phone: 480-551-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: