Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KODY WALLACE
Active Sole ProprietorKODY WALLACE is a Physical Therapy Assistant healthcare provider located in MINERAL WELLS, Texas. NPI 1912061607 is currently active in the NPPES registry. Verify at CMS.
Physical Therapy Assistant · MINERAL WELLS, TX
Registration Details
- NPI Number
- 1912061607
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 20, 2006 (19.620076051028 yrs)
- Last Updated
- Jul 8, 2007
- License
-
1141471 (TX)
- Sole Proprietor
- Yes
Practice Information
- Address
-
400 SW 25TH AVEMINERAL WELLS, TX, 760678246Browse TX providers · Browse ZIP 76067
- Phone
- 9403286580
- Fax
- 9403286550
- Primary Specialty
-
Physical Therapy Assistant
225100000X
Other Physical Therapy Assistant Providers in MINERAL WELLS, TX
| Name | Credential | NPI |
|---|---|---|
| MRS. GWENDOLYN MOORE JONES | LPT | 1154389773 |
| MR. MICHAEL JOSEPH GREMMINGER | LPT | 1861450488 |
| BRANDON WADE HONS | — | 1730396185 |
| ELIZABETH OLIVE CAMERON | P.T. | 1265642649 |
| CHONTELL DENISE HOLDMAN | PT | 1821322827 |
| AMY BRIDGES ESWEIN | — | 1679833891 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.