Provider Demographics
NPI:1083174759
Name:RAINEY, CODY LEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:LEE
Last Name:RAINEY
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 1:39 ZIRCON DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6052
Mailing Address - Country:US
Mailing Address - Phone:870-723-9647
Mailing Address - Fax:
Practice Address - Street 1:629 JACK STEPHENS DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5525
Practice Address - Country:US
Practice Address - Phone:501-526-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist