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General NPI Number Information
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NPI Number | 1043814999
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Entity Type | Individual
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Provider Name | CODY ALLRED
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Gender | Male
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Dates
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Enumeration Date | 11/22/2020
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Last Update Date | 11/22/2020
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Provider Practice Location Address
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Address Line | 7101 VIRGINIA PKWY
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City | MCKINNEY
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State | TX
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Zip | 75071-5753
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Country | US
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Telephone | 806-544-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 VIRGINIA PKWY APT 123
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City | MCKINNEY
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State | TX
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Zip | 75071-5754
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Country | US
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Telephone | 806-544-0003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2155315
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License Number State | TX
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