Healthcare Provider Details

I. General information

NPI: 1023629490
Provider Name (Legal Business Name): JUSTIN KODY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 INVERNESS DR W STE 100
ENGLEWOOD CO
80112-5066
US

IV. Provider business mailing address

590 N LOGAN ST
DENVER CO
80203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 303-694-3333
  • Fax: 303-694-9666
Mailing address:
  • Phone: 970-624-1103
  • Fax: 970-490-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0018002
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: