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General NPI Number Information
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NPI Number | 1184406696
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Entity Type | Individual
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Provider Name | CODY GAWLITTA
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Gender | Male
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 3117 STILLWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7164
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Country | US
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Telephone | 928-442-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 25121 N 103RD AVE
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City | PEORIA
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State | AZ
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Zip | 85383-2785
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | LPT-33176
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License Number State | AZ
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