Provider Demographics
NPI:1073011359
Name:CARSON, CODY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:CARSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 INDUSTRIAL LN
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6311
Mailing Address - Country:US
Mailing Address - Phone:423-569-3443
Mailing Address - Fax:423-569-2616
Practice Address - Street 1:530 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6311
Practice Address - Country:US
Practice Address - Phone:423-569-3443
Practice Address - Fax:423-569-2616
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist