Provider Demographics
NPI:1669823993
Name:MISURACA, CODY A (DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:MISURACA
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 1:10330 MERIDIAN AVE N STE 110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9484
Mailing Address - Country:US
Mailing Address - Phone:206-668-6032
Mailing Address - Fax:
Practice Address - Street 1:10330 MERIDIAN AVE N STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9484
Practice Address - Country:US
Practice Address - Phone:206-668-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292100225100000X
MN10324225100000X
WA61268452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist