Provider Demographics
NPI:1073240073
Name:ADAMS, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 ILSLEY RD
Mailing Address - Street 2:
Mailing Address - City:DAWSON SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42408-9642
Mailing Address - Country:US
Mailing Address - Phone:270-621-0180
Mailing Address - Fax:
Practice Address - Street 1:300 BEECH ST
Practice Address - Street 2:
Practice Address - City:KUTTAWA
Practice Address - State:KY
Practice Address - Zip Code:42055-6214
Practice Address - Country:US
Practice Address - Phone:270-388-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant