Provider Demographics
NPI:1366937955
Name:STUBBLEFIELD, CODY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:STUBBLEFIELD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N ELLA ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-3214
Mailing Address - Country:US
Mailing Address - Phone:615-519-6460
Mailing Address - Fax:
Practice Address - Street 1:301 N ELLA ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-3214
Practice Address - Country:US
Practice Address - Phone:501-268-8315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT7972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer