Provider Demographics
NPI:1114492667
Name:GORE, COURTNEY THOMPSON (DPT)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:THOMPSON
Last Name:GORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N FERN ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8981
Mailing Address - Country:US
Mailing Address - Phone:919-647-4763
Mailing Address - Fax:
Practice Address - Street 1:111 N FERN ABBEY LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8981
Practice Address - Country:US
Practice Address - Phone:919-647-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist