Individual
CODY MASON HERBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
512 CAMPUS RD., TEAGLE HALL, ITHACA, NY 14850
(607) 255-4237
Mailing address
110 W MARSHALL ST, APT 2, ITHACA, NY 14850-3546
(973) 903-7663
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
002075-1
NY
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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