Provider Demographics
NPI:1275824708
Name:FASSETT, COURTNEY (LMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FASSETT
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 1:8101 E LOWRY BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8101 E LOWRY BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7196
Practice Address - Country:US
Practice Address - Phone:303-341-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11793OtherSTATE LICENSE