Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A5198 | MD |
NPI | 1003467010 |
---|---|
Provider Name | Cody Matthew Rea |
First Address | Elkton, MD 21921-2245 |
Second Address | Christianstead, VI 00820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 23/09/2019 |