Healthcare Provider Details

I. General information

NPI: 1952192940
Provider Name (Legal Business Name): CODY WOLFORD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LAND GRANT STREET SUITE 3
ST AUGUSTINE FL
32092-2260
US

IV. Provider business mailing address

73 MELLOWOOD LN
ST AUGUSTINE FL
32092-3398
US

V. Phone/Fax

Practice location:
  • Phone: 904-580-3148
  • Fax:
Mailing address:
  • Phone: 540-327-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: