MEDICARE: CODY ABBOTT 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	261QP2000X	Physical Therapy Clinic/Center	1306652	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	1306652	TX
3	225100000X	Physical Therapist	1306652	TX

General Provider Information

NPI Number	:	1770061632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY ABBOTT DPT

Provider Business Mailing Address
First Line	:	2114 TEXOMA PKWY STE 650
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2692
Country	:	US
Telephone Number	:	39-813-1551
Fax Number	:	903-813-1725

Provider Business Practice Location Address
First Line	:	2114 TEXOMA PKWY STE 650
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2692
Country	:	US
Telephone Number	:	903-813-1551
Fax Number	:	903-813-1725

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	11/01/2023

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