Individual
MR. CODY LEE CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
5800 W FRIENDLY AVE, GREENSBORO, NC 27410-4108
(336) 316-2513
Mailing address
4600 BIG TREE WAY APT 5V, GREENSBORO, NC 27409-2784
(336) 905-5447
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-2983
NC
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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