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General NPI Number Information
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NPI Number | 1114473162
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Entity Type | Individual
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Provider Name | CODY JAMES SMALL DPT
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Gender | Male
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 9105 E 56TH ST STE I
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City | INDIANAPOLIS
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State | IN
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Zip | 46216-2231
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Country | US
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Telephone | 463-207-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9221
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4703
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05014543A
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License Number State | IN
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