Provider Demographics
NPI:1942697552
Name:LEMMONS, CODY JOHN (PT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:JOHN
Last Name:LEMMONS
Suffix:
Gender:M
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 HICKORY WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-6022
Mailing Address - Country:US
Mailing Address - Phone:901-301-3688
Mailing Address - Fax:
Practice Address - Street 1:2308 HICKORY WOOD AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-6022
Practice Address - Country:US
Practice Address - Phone:901-301-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT70562255A2300X
AR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer