Provider Demographics
NPI:1033637772
Name:SOUTER, COURTNEY E (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:SOUTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 REINEKERS LN STE GR4
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2871
Mailing Address - Country:US
Mailing Address - Phone:703-299-3111
Mailing Address - Fax:703-299-1556
Practice Address - Street 1:225 REINEKERS LN STE GR4
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2871
Practice Address - Country:US
Practice Address - Phone:703-299-3111
Practice Address - Fax:703-299-1556
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty