Provider Demographics
NPI:1871897637
Name:PREMO, CODY ALLEN (QMHA)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:ALLEN
Last Name:PREMO
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3563
Mailing Address - Country:US
Mailing Address - Phone:775-322-4650
Mailing Address - Fax:775-322-3137
Practice Address - Street 1:690 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3563
Practice Address - Country:US
Practice Address - Phone:775-322-4650
Practice Address - Fax:775-322-3137
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner