Healthcare Provider Details

I. General information

NPI: 1992196059
Provider Name (Legal Business Name): CODY KECK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W SPRING ST
COOKEVILLE TN
38501-7102
US

IV. Provider business mailing address

800 CRESCENT CENTRE DR STE 300
FRANKLIN TN
37067-7285
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-9518
  • Fax: 931-372-0087
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10301
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: