Provider Demographics
NPI:1578165403
Name:HEGEDUS, CODY JAMES
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
Last Name:HEGEDUS
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 1:514 N MARIAN ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1216
Mailing Address - Country:US
Mailing Address - Phone:814-241-8703
Mailing Address - Fax:
Practice Address - Street 1:336 BLOOMFIELD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3271
Practice Address - Country:US
Practice Address - Phone:814-269-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT026257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist