Provider Demographics
NPI:1851783450
Name:BRUMM, CODY (PT, DPT, AT, ATC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:BRUMM
Suffix:
Gender:M
Credentials:PT, DPT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 THORNAPPLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49073-9789
Mailing Address - Country:US
Mailing Address - Phone:269-838-6231
Mailing Address - Fax:
Practice Address - Street 1:8635 THORNAPPLE LAKE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:MI
Practice Address - Zip Code:49073-9789
Practice Address - Country:US
Practice Address - Phone:269-838-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI5501019697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer