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General NPI Number Information
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NPI Number | 1154464709
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Entity Type | Individual
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Provider Name | CODY JOHNSON PT
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 820 S ALMA DR STE 100
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City | ALLEN
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State | TX
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Zip | 75013-3809
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Country | US
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Telephone | 214-383-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 15625 QUORUM DR APT 3111
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City | ADDISON
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State | TX
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Zip | 75001-6638
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Country | US
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Telephone | 214-383-2641
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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 | 1152858
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License Number State | TX
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