Provider Demographics
NPI:1891918785
Name:BARNETT, CODY G (PT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:G
Last Name:BARNETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7015 E CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1943
Mailing Address - Country:US
Mailing Address - Phone:316-558-8808
Mailing Address - Fax:316-558-8818
Practice Address - Street 1:430 N WOODLAWN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4334
Practice Address - Country:US
Practice Address - Phone:316-558-8808
Practice Address - Fax:316-558-8818
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140944Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
KSQ50449Medicare UPIN