Provider Demographics
NPI:1194381053
Name:KIRCHNER, COURTNEY NICOLE (PTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICOLE
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN VALLEYS
Mailing Address - State:PA
Mailing Address - Zip Code:17360-8547
Mailing Address - Country:US
Mailing Address - Phone:717-668-2831
Mailing Address - Fax:
Practice Address - Street 1:425 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9270
Practice Address - Country:US
Practice Address - Phone:717-637-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012141225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant