=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801371141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CODY JONES DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2018
-----------------------------------------------------
Last Update Date | 10/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 S SETON AVE
-----------------------------------------------------
City | EMMITSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21727-9226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-447-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2820 OLD WASHINGTON RD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21157-7548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-827-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT26146
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------