Provider Demographics
NPI:1396400057
Name:REELEY, CODY J
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:J
Last Name:REELEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 4TH ST NE UNIT 311
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-5502
Mailing Address - Country:US
Mailing Address - Phone:217-549-1495
Mailing Address - Fax:
Practice Address - Street 1:1151 4TH ST NE UNIT 311
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-5502
Practice Address - Country:US
Practice Address - Phone:217-549-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program