MEDICARE: DANIEL CODY CARMACK 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

General Provider Information

NPI Number	:	1649648213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL CODY CARMACK DPT

Provider Business Mailing Address
First Line	:	18 NEWBRIDGE PKWY UNIT 402
Second Line	:
City	:	WOODFIN
State	:	NC
Zip	:	28804-0110
Country	:	US
Telephone Number	:	828-407-0368
Fax Number	:	828-589-6189

Provider Business Practice Location Address
First Line	:	554 RIVERSIDE DR STE C
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28801-2108
Country	:	US
Telephone Number	:	828-407-0368
Fax Number	:

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

Provider Enumeration Date	:	09/12/2015
Last Update Date	:	01/23/2023

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