Provider Demographics
NPI:1306461462
Name:MIGLIORE, CODY (DPT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MIGLIORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2664
Mailing Address - Country:US
Mailing Address - Phone:504-655-3130
Mailing Address - Fax:
Practice Address - Street 1:1972 ORMOND BLVD
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-3818
Practice Address - Country:US
Practice Address - Phone:985-307-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist