MEDICARE: CODY JAMES DORNAK DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1320471	TX

General Provider Information

NPI Number	:	1225678055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY JAMES DORNAK DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 FM 723 RD STE 107
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-8808
Country	:	US
Telephone Number	:	832-615-0527
Fax Number	:	832-615-3107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	07/17/2024

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