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NPI Code Detail

MEDICARE: CODY SUDER

MEDICARE:   CODY  SUDER
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
1225100000XPhysical TherapistPT-6002ID
2225100000XPhysical Therapist24541MT

General Provider Information

NPI Number : 1710456348
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY SUDER
Provider Business Mailing Address
First Line : 100 WESTVIEW PARK PL
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3074
Country : US
Telephone Number : 406-393-2474
Fax Number : 406-393-2475
Provider Business Practice Location Address
First Line : 100 WESTVIEW PARK PL
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3074
Country : US
Telephone Number : 406-393-2474
Fax Number : 406-393-2475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2018
Last Update Date : 08/22/2023

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Directions to “ CODY SUDER ” Practice Location

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