Provider Demographics
NPI:1609460286
Name:MARTUCCI, CODY (DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MARTUCCI
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 1:3 SPRINGHURST DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2261
Mailing Address - Country:US
Mailing Address - Phone:518-479-7172
Mailing Address - Fax:518-286-3798
Practice Address - Street 1:3 SPRINGHURST DR
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2261
Practice Address - Country:US
Practice Address - Phone:518-479-7172
Practice Address - Fax:518-286-3798
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist