Provider Demographics
NPI:1962816314
Name:HARTLEY, CODY JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1110
Mailing Address - Country:US
Mailing Address - Phone:919-791-6260
Mailing Address - Fax:
Practice Address - Street 1:4959 BILL GARDNER PKWY STE 109
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248
Practice Address - Country:US
Practice Address - Phone:770-914-9285
Practice Address - Fax:770-914-5668
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013303225100000X
WVPT 003309225100000X
NCP19494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist