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General NPI Number Information
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NPI Number | 1730793605
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Entity Type | Individual
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Provider Name | CODY CRAIG DPT
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Gender | Male
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1001 E BOGARD RD
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City | WASILLA
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State | AK
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Zip | 99654-7114
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Country | US
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Telephone | 907-373-7246
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Fax | 907-376-9225
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Provider Business Mailing Address
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Address Line | 560 S LOOP RD
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City | EDGEWOOD
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State | KY
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Zip | 41017-3405
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Country | US
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Telephone | 859-301-2663
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Fax | 859-817-7848
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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 | 05013942A
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License Number State | IN
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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 | 244576
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License Number State | AK
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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 | 009174
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CV2003640
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License Number State | IN
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