Healthcare Provider Details

I. General information

NPI: 1679405401
Provider Name (Legal Business Name): MATTHEW ROBERT CODA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 S 20 MILE RD
PARKER CO
80134-6453
US

IV. Provider business mailing address

11048 TWENTY MILE RD APT 102
PARKER CO
80134-5102
US

V. Phone/Fax

Practice location:
  • Phone: 720-851-6695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0021296
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: