MEDICARE: CODY BRUMM PT, DPT, AT, ATC

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	2255A2300X	Athletic Trainer
2	225100000X	Physical Therapist	5501019697	MI

General Provider Information

NPI Number	:	1851783450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY BRUMM PT, DPT, AT, ATC

Provider Business Mailing Address
First Line	:	8635 THORNAPPLE LAKE RD
Second Line	:
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9789
Country	:	US
Telephone Number	:	269-838-6231
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 THORNAPPLE LAKE RD
Second Line	:
City	:	NASHVILLE
State	:	MI
Zip	:	49073-9789
Country	:	US
Telephone Number	:	269-838-6231
Fax Number	:

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

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	08/28/2020

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