Individual
CODY GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
823 PARKCENTRE WAY, NAMPA, ID 83651-1783
(800) 926-2588
Mailing address
4112 PINTAIL LN, NAMPA, ID 83686-8734
(701) 721-3506
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/12/2021
Last updated
07/12/2021
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