Provider Demographics
NPI:1780112409
Name:CODY, PRISCILLA LEA (PT, DPT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LEA
Last Name:CODY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:LEA
Other - Last Name:PAOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:22120 MIDLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3554
Mailing Address - Country:US
Mailing Address - Phone:913-745-4064
Mailing Address - Fax:913-745-4352
Practice Address - Street 1:11340 NALL AVE STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1234
Practice Address - Country:US
Practice Address - Phone:913-354-5020
Practice Address - Fax:913-354-5009
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06696225100000X, 225100000X
MO2017029165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist