Individual
CODY DERBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
2301 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2909
(863) 413-4116
Mailing address
2301 LAKELAND HILLS BLVD, LAKELAND, FL 33805-2909
(863) 413-4116
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2017002382
MO
2255A2300X
Athletic Trainer
Primary
AL5128
FL
Other
Enumeration date
01/29/2017
Last updated
01/27/2021
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