Provider Demographics
NPI:1376053520
Name:GINGERICH, CODY RAY (DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:RAY
Last Name:GINGERICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4240
Mailing Address - Country:US
Mailing Address - Phone:937-623-1975
Mailing Address - Fax:
Practice Address - Street 1:1320 HAMPTON AVE STE 11B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1044
Practice Address - Country:US
Practice Address - Phone:864-900-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X, 390200000X
VA2305212173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program