Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 00861 | IA |
NPI | 1013113968 |
---|---|
Provider Name | Daniel Dee Cody |
First Address | Story City, IA 50248-8718 |
Second Address | Dayton, IA 50530-7530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 08/07/2007 |