Provider Demographics
NPI:1275730624
Name:BEVERAGE ASH, COURTNEY WENDELL (PT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:WENDELL
Last Name:BEVERAGE ASH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 S. MAIN
Mailing Address - Street 2:FONDREN ORTHOPEDIC GROUP L.L.P
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4509
Mailing Address - Country:US
Mailing Address - Phone:713-799-2300
Mailing Address - Fax:713-794-3380
Practice Address - Street 1:601 ROCKMEAD DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-5115
Practice Address - Fax:281-359-2663
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 009732225100000X
WV002123225100000X
TX1175853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365496Medicaid