Individual
CODY DEARDORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAT, LAT, ATC
Contact information
Practice address
3211 47TH ST, LUBBOCK, TX 79413-4112
(806) 219-2042
(806) 766-0705
Mailing address
13407 INDIANA AVE APT 2108, LUBBOCK, TX 79423-1869
(806) 787-7828
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT7951
TX
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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