Individual
MR. CODY DON NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3027 HWY 364 EAST, WYNNE, AR 72387
(870) 588-2408
Mailing address
1011 MARION DR, WYNNE, AR 72396-2428
(870) 588-2408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4335
AR
Other
Enumeration date
08/14/2012
Last updated
10/09/2018
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