Provider Demographics
NPI:1073255998
Name:SEAGREN, COURTNEY (LMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SEAGREN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3037
Mailing Address - Country:US
Mailing Address - Phone:815-222-6520
Mailing Address - Fax:
Practice Address - Street 1:118 S 2ND ST
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1308
Practice Address - Country:US
Practice Address - Phone:509-698-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61132944225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist