Provider Demographics
NPI:1154710036
Name:TRAHAN TANT, CODY (PT, DPT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:TRAHAN TANT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:
Other - Last Name:TRAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77631-0112
Mailing Address - Country:US
Mailing Address - Phone:409-920-4105
Mailing Address - Fax:
Practice Address - Street 1:3920 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1756
Practice Address - Country:US
Practice Address - Phone:409-920-4105
Practice Address - Fax:409-920-4107
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1253907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist