Provider Demographics
NPI:1164161741
Name:SVOBODA, CODY WILLIAM (STUDENT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:WILLIAM
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 PLATT ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3562
Mailing Address - Country:US
Mailing Address - Phone:620-323-0191
Mailing Address - Fax:
Practice Address - Street 1:1869 PLATT ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3562
Practice Address - Country:US
Practice Address - Phone:620-323-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer