Individual
CODY JAMES VAN DE VEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
417 E SAINT JOSEPH ST, PERRYVILLE, MO 63775-2024
(573) 208-8607
Mailing address
25117 SW PARKWAY AVE STE D, WILSONVILLE, OR 97070-9697
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2016023482
MO
Other
Enumeration date
06/07/2017
Last updated
06/07/2017
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