Provider Demographics
NPI:1811773583
Name:HISLE, CODY B (DPT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:B
Last Name:HISLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2389
Mailing Address - Country:US
Mailing Address - Phone:859-385-4888
Mailing Address - Fax:859-757-0088
Practice Address - Street 1:1932 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2389
Practice Address - Country:US
Practice Address - Phone:859-385-4888
Practice Address - Fax:859-757-0088
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist