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General NPI Number Information
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NPI Number | 1992394910
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Entity Type | Individual
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Provider Name | LUKE CODY
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Gender | Male
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 480 CAROLINA DR NW APT 49
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City | JACKSONVILLE
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State | AL
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Zip | 36265-1452
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Country | US
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Telephone | 256-399-2398
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Fax |
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Provider Business Mailing Address
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Address Line | 130 HICKORY RIDGE DRIVE
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City | GLENCOE
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State | AL
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Zip | 35905
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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