Provider Demographics
NPI:1073059986
Name:GALVAN, COURTNEY LEIGH (ATC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:GALVAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:16674 E LOUISIANA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4108
Mailing Address - Country:US
Mailing Address - Phone:720-220-9919
Mailing Address - Fax:
Practice Address - Street 1:6900 E 47TH AVENUE DR STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3401
Practice Address - Country:US
Practice Address - Phone:303-920-1200
Practice Address - Fax:303-920-1281
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.0001558390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22OtherATHLETIC TRAINER