Individual provider Active NPI

Cody Migliore, DPT

  • Physical Therapist
  • Destrehan, LA
National Provider Identifier
1306461462
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10641 Issued in LA
Practice address
1972 Ormond Blvd
Destrehan, LA 70047-3818
Phone
(985) 307-0925
NPI assigned
Jun 14, 2020
Last updated
Aug 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10641 LA Primary

Addresses

Primary practice location

1972 Ormond Blvd
Destrehan, LA 70047-3818

Mailing address

4208 Lemon St
Metairie, LA 70006-2664
Phone (504) 655-3130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200928001259 LA Practitioner - Physical Therapist in Private Practice 2769801620 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10641LAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
River Region Rehab, LLC Physical Therapist CurrentSince Aug 17, 2020 Accepting new patients

Locations

1972 Ormond Blvd
Ste D
Destrehan, LA 70047
Phone (985) 307-0925

12371 Highway 90
Ste D
Luling, LA 70070
Phone (985) 331-1001

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1306461462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4208 LEMON ST",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062664",
            "telephone_number": "504-655-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1972 ORMOND BLVD",
            "city": "DESTREHAN",
            "state": "LA",
            "postal_code": "700473818",
            "telephone_number": "985-307-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIGLIORE",
        "first_name": "CODY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-14",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "10641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Destrehan, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.