Cody Blake Dillon, PTA
Individual provider Active NPI Physical Therapy Assistant · Princeton, WV
NPI 1174267751 · NPPES record last updated Apr 21, 2022
Key facts
- NPI
- 1174267751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 002418 (WV)
- Practice address
- 1908 Glenwood Park Rd
Princeton, WV 24739-7969 - Phone
- (304) 323-2300
- NPI assigned
- Apr 21, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
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 |
|---|---|---|---|
| 002418 | WV | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stonerise Reliable Healthcare LLC | Past |
Accepting new patients | |
| Stonerise Reliable Healthcare LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 002418 | WV | Yes |
Addresses
Primary practice location
1908 Glenwood Park Rd
Princeton, WV 24739-7969
Mailing address
526 White Pines Rd
Princeton, WV 24739-8750
Other providers in Princeton, WV
- Alan Louis Desmond
- Carl Andrew Desplaines
- Lindsey Devaughn
- Staccotta Dickerson
- Ashley Diffenbach
- Rory Dillon
- Theresa Dillon
- Jessica Dillow-Price
- Haley Morgan Dillow
- Katherine Dillow
All providers in Princeton, WV · Physical Therapy Assistant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2022. 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.