Provider Demographics
NPI:1801016720
Name:COODY, LOUIS W (PTA)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:W
Last Name:COODY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3207
Mailing Address - Country:US
Mailing Address - Phone:956-584-3686
Mailing Address - Fax:
Practice Address - Street 1:7017 N 10TH ST
Practice Address - Street 2:STE T
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3287
Practice Address - Country:US
Practice Address - Phone:956-630-6300
Practice Address - Fax:956-630-3443
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2034916225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant