Provider Demographics
NPI:1043676042
Name:WHITE, COURTNEY (ATC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 SW KINNAMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2447
Mailing Address - Country:US
Mailing Address - Phone:541-231-4087
Mailing Address - Fax:
Practice Address - Street 1:7300 SW CHILDS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7772
Practice Address - Country:US
Practice Address - Phone:503-207-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer