Provider Demographics
NPI:1043852759
Name:WRIGHT, CODY A
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 CENTRAL PARKWAY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5240
Mailing Address - Country:US
Mailing Address - Phone:330-891-7526
Mailing Address - Fax:
Practice Address - Street 1:2307 CENTRAL PARKWAY AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5240
Practice Address - Country:US
Practice Address - Phone:330-891-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTJ576730175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist