Individual
CODY ALLEN WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1539 COUNTRY CLUB RD, FAIRMONT, WV 26554-1306
(304) 366-9100
Mailing address
837 MONONGALIA AVE, MORGANTOWN, WV 26505-5732
(724) 713-8106
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003879
WV
Other
Enumeration date
01/18/2018
Last updated
01/18/2018
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