Basic Information
| Provider Information | |||||||||
| NPI: | 1538713185 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VECCHIO | ||||||||
| FirstName: | CODY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9097 E DESERT COVE AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805514965 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5215 W BASELINE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LAVEEN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853392943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232194600 | ||||||||
| FaxNumber: | 6232194601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2019 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.