Individual
MR. CODY ROBERT CORNTASSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
415 OWEN LN APT 713, WACO, TX 76710-8910
(918) 961-1527
Mailing address
415 OWEN LN APT 713, WACO, TX 76710-8910
(918) 961-1527
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5653
TX
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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