Provider Demographics
NPI:1679099980
Name:OSBOURN, CODY JOE (PT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JOE
Last Name:OSBOURN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 JOHNSON MILL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5026
Mailing Address - Country:US
Mailing Address - Phone:479-404-4500
Mailing Address - Fax:479-404-4510
Practice Address - Street 1:3561 JOHNSON MILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5026
Practice Address - Country:US
Practice Address - Phone:479-404-4500
Practice Address - Fax:479-404-4510
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist