Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | MA | |
Y | 2251X0800X | Physical Therapist - Orthopedic | PTL.0018002 | CO |
NPI | 1023629490 |
---|---|
Provider Name | Justin Kody |
First Address | Fountain, CO 80817-1563 |
Second Address | Fountain, CO 80817-1563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2020 |
Last Update Date | 19/12/2021 |