Provider Demographics
NPI:1043555105
Name:PEART, COURTNEY LYN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYN
Last Name:PEART
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-9442
Mailing Address - Country:US
Mailing Address - Phone:509-698-8586
Mailing Address - Fax:
Practice Address - Street 1:801 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-9442
Practice Address - Country:US
Practice Address - Phone:509-698-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer