Provider Demographics
NPI:1275943623
Name:BROTHERS, COURTNEY (MS, ATC, PES)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1219
Mailing Address - Country:US
Mailing Address - Phone:339-227-7807
Mailing Address - Fax:
Practice Address - Street 1:4 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1219
Practice Address - Country:US
Practice Address - Phone:339-227-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer