Provider Demographics
NPI:1427787258
Name:PORTER, CODY NATHAN (DPT, PT)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:NATHAN
Last Name:PORTER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FOLLY ROAD BLVD UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7596
Mailing Address - Country:US
Mailing Address - Phone:864-436-6776
Mailing Address - Fax:
Practice Address - Street 1:1341 OLD GEORGETOWN RD STE C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7307
Practice Address - Country:US
Practice Address - Phone:843-936-3385
Practice Address - Fax:843-388-4868
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist