Provider Demographics
NPI:1649870403
Name:MURRAY, CODY (CMT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 AGNES AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2733
Mailing Address - Country:US
Mailing Address - Phone:818-792-6329
Mailing Address - Fax:
Practice Address - Street 1:5325 AGNES AVE APT 4
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2733
Practice Address - Country:US
Practice Address - Phone:818-792-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78738225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist