Provider Demographics
NPI:1073028031
Name:GRETH, COURTNEY ANNE (ATC, LMT)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ANNE
Last Name:GRETH
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2907
Mailing Address - Country:US
Mailing Address - Phone:303-832-3668
Mailing Address - Fax:
Practice Address - Street 1:980 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2907
Practice Address - Country:US
Practice Address - Phone:303-832-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist