Cody Conrad Merrill, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160008092 Issued in IL

Practice address

811 S 10TH St
Oregon, IL 61061-2129

Phone

(815) 732-7994

NPI assigned

Mar 16, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1356042386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 DEVONSHIRE ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211116",
            "telephone_number": "815-441-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S 10TH ST",
            "city": "OREGON",
            "state": "IL",
            "postal_code": "610612129",
            "telephone_number": "815-732-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "CODY",
        "middle_name": "CONRAD",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160008092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliette A Kalweit Schmeling, M.D.
• Ashleigh Lamb
• Sierra Leek, BS, MHP
• Odette Little, MA(CCC-SLP)L
• Jennifer Meisel
• Dawn Henderson Meyer
• Sara E. Modrzejewski
• Mark K Myers, M.D.
• Brittany Lee Nelson, LCSW
• Michael D Nelson, DC

• Physical Therapy Assistant in Oregon, IL
• Providers in Oregon, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.