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General NPI Number Information
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NPI Number | 1780534115
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Entity Type | Individual
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Provider Name | CODY DEAN CANTRELL
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Gender | Male
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 3999 RICHMOND RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-6046
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Country | US
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Telephone | 440-848-6087
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Fax |
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Provider Business Mailing Address
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Address Line | 7786 SHADY LN
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City | NORTHFIELD
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State | OH
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Zip | 44067-2730
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Country | US
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Telephone | 440-478-1085
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT020233
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License Number State | OH
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