Provider Demographics
NPI:1275028474
Name:SMITH, COURTNEY RAE (BS, ATC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 BILL DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80116-8900
Mailing Address - Country:US
Mailing Address - Phone:720-318-3028
Mailing Address - Fax:
Practice Address - Street 1:146 BILL DAVIS RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:CO
Practice Address - Zip Code:80116-8900
Practice Address - Country:US
Practice Address - Phone:720-318-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00008912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer