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General NPI Number Information
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NPI Number | 1669823993
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Entity Type | Individual
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Provider Name | CODY A MISURACA DPT
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 10330 MERIDIAN AVE N STE 110
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City | SEATTLE
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State | WA
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Zip | 98133-9484
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Country | US
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Telephone | 206-668-6032
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 MERIDIAN AVE N STE 110
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City | SEATTLE
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State | WA
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Zip | 98133-9484
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Country | US
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Telephone | 206-668-6032
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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 | PT292100
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License Number State | CA
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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 | 10324
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License Number State | MN
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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 | 61268452
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License Number State | WA
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