Provider Demographics
NPI:1649550088
Name:TRUEBENBACH, KODY JOE (DPT)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:JOE
Last Name:TRUEBENBACH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3301 SUNDOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8032
Mailing Address - Country:US
Mailing Address - Phone:940-387-3700
Mailing Address - Fax:940-488-4513
Practice Address - Street 1:8800 US HIGHWAY 380 STE 100
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2515
Practice Address - Country:US
Practice Address - Phone:940-365-9200
Practice Address - Fax:940-222-5598
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1265117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist