Provider Demographics
NPI:1043950637
Name:COURTRIGHT, SAMUEL (ACSM-EP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:COURTRIGHT
Suffix:
Gender:M
Credentials:ACSM-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ORLIN AVE SE # 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3520
Mailing Address - Country:US
Mailing Address - Phone:952-356-2022
Mailing Address - Fax:
Practice Address - Street 1:138 ORLIN AVE SE # 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3520
Practice Address - Country:US
Practice Address - Phone:952-356-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1038189224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist