Provider Demographics
NPI:1578598645
Name:OKUDA, CODY RYAN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:RYAN
Last Name:OKUDA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1859
Mailing Address - Country:US
Mailing Address - Phone:702-876-1733
Mailing Address - Fax:702-878-2018
Practice Address - Street 1:7125 GRAND MONTECITO PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0260
Practice Address - Country:US
Practice Address - Phone:702-515-1540
Practice Address - Fax:702-515-1578
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDQ924ZMedicare PIN