Cody Matthew Rea
Individual provider Active NPI Physical Therapy Assistant · Christianstead, VI
NPI 1003467010 · NPPES record last updated Sep 23, 2019
Key facts
- NPI
- 1003467010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A5198 (MD)
- Practice address
- 4201 (201-202) Estate Ruby
Christianstead, VI 00820 - Phone
- (340) 718-2665
- Fax
- (340) 718-2611
- NPI assigned
- Sep 23, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A5198 | MD | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A5198 | MD | Yes |
Addresses
Primary practice location
4201 (201-202) Estate Ruby
Christianstead, VI 00820
Mailing address
25 Anna Speakman Rd
Elkton, MD 21921-2245
Phone (443) 945-5868
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.