Individual
CODY WALKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4411 BEAVER AVE, DES MOINES, IA 50310-3748
(515) 401-2086
Mailing address
4411 BEAVER AVE, DES MOINES, IA 50310-3748
(515) 401-2086
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
113044
IA
225100000X
Physical Therapist
11771
MN
225100000X
Physical Therapist
62149
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114467131
—
MN
Enumeration date
02/24/2017
Last updated
08/17/2022
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