Healthcare Provider Details

I. General information

NPI: 1568997948
Provider Name (Legal Business Name): CODY MCGRATH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MARATHON BLVD SUITE 204
AUSTIN TX
78756-3436
US

IV. Provider business mailing address

4201 MARATHON BLVD SUITE 204
AUSTIN TX
78756-3436
US

V. Phone/Fax

Practice location:
  • Phone: 512-358-1400
  • Fax: 737-300-2519
Mailing address:
  • Phone: 512-358-1400
  • Fax: 737-300-2519

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: