Provider Demographics
NPI:1639759467
Name:LYFORD, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:LYFORD
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:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-1424
Mailing Address - Country:US
Mailing Address - Phone:207-227-2500
Mailing Address - Fax:
Practice Address - Street 1:17 CHIPMAN WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1039
Practice Address - Country:US
Practice Address - Phone:781-585-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist