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General NPI Number Information
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NPI Number | 1790340693
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Entity Type | Individual
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Provider Name | CODY D MOON DPT/ ATC
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 10815 COLONEL GLENN RD STE 500
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8041
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Country | US
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Telephone | 501-406-9201
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Fax | 501-320-7813
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Provider Business Mailing Address
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Address Line | 4301 W MARKHAM ST # 783
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-686-8000
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Fax | 501-526-5148
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2018016971
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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