Provider Demographics
NPI:1902000920
Name:THOMPSON, CODY ALEX (PT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ALEX
Last Name:THOMPSON
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 1:2742 LAKE VIEW DR
Mailing Address - Street 2:APT 646
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3533
Mailing Address - Country:US
Mailing Address - Phone:615-618-6266
Mailing Address - Fax:
Practice Address - Street 1:7047 OLD MADISON PIKE NW
Practice Address - Street 2:SUITE 305
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4500
Practice Address - Country:US
Practice Address - Phone:256-922-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist