Provider Demographics
NPI:1033581327
Name:WASHBURN, CODIE (ATC)
Entity type:Individual
Prefix:MRS
First Name:CODIE
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MS
Other - First Name:CODIE
Other - Middle Name:
Other - Last Name:HILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UWA STATION #14
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UWA STATION #14
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:205-652-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1550OtherSTATE LICENSURE
AL2000012354OtherBOARD OF CERTIFICATION NUMBER