MEDICARE: CODY MURRAY CMT

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	225700000X	Massage Therapist	78738	CA

General Provider Information

NPI Number	:	1649870403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY MURRAY CMT

Provider Business Mailing Address
First Line	:	5325 AGNES AVE APT 4
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2733
Country	:	US
Telephone Number	:	818-792-6329
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 AGNES AVE APT 4
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2733
Country	:	US
Telephone Number	:	818-792-6329
Fax Number	:

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

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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