Individual
MR. CODY CONRAD MERRILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
811 S 10TH ST, OREGON, IL 61061-2129
(815) 732-7994
Mailing address
405 DEVONSHIRE ST, DIXON, IL 61021-1116
(815) 441-9965
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008092
IL
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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