Individual
MR. CODY RYAN WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
11850 BROADWAY ST, PEARLAND, TX 77584-3972
(281) 299-2127
Mailing address
330 KENDALL CREST DR, ALVIN, TX 77511-5128
(281) 299-2127
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT4303
TX
390200000X
Student in an Organized Health Care Education/Training Program
070802059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINER
TX
Enumeration date
10/14/2016
Last updated
01/05/2021
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