Healthcare Provider Details

I. General information

NPI: 1265867022
Provider Name (Legal Business Name): DEVYN CUDWORTH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 GEAR ST
RENO NV
89503-2838
US

IV. Provider business mailing address

631 GEAR ST
RENO NV
89503-2838
US

V. Phone/Fax

Practice location:
  • Phone: 775-338-7839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: