Provider Demographics
NPI:1710122544
Name:CODD, MEREDITH (LMT)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:CODD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9841 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6100
Mailing Address - Country:US
Mailing Address - Phone:954-435-4380
Mailing Address - Fax:954-435-9627
Practice Address - Street 1:9841 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6100
Practice Address - Country:US
Practice Address - Phone:954-435-4380
Practice Address - Fax:954-435-9627
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist