Provider Demographics
NPI:1467142455
Name:MABE, PATRICK CODY (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CODY
Last Name:MABE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:MABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:2230 PARK RD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6664
Practice Address - Country:US
Practice Address - Phone:704-919-1280
Practice Address - Fax:704-919-0580
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist