Healthcare Provider Details

I. General information

NPI: 1710122544
Provider Name (Legal Business Name): MEREDITH CODD L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 PINES BLVD
PEMBROKE PINES FL
33024-6100
US

IV. Provider business mailing address

9841 PINES BLVD
PEMBROKE PINES FL
33024-6100
US

V. Phone/Fax

Practice location:
  • Phone: 954-435-4380
  • Fax: 954-435-9627
Mailing address:
  • Phone: 954-435-4380
  • Fax: 954-435-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA46685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: