Provider Demographics
NPI:1285179838
Name:MARSHALL, COURTNEY CAUTHEN (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CAUTHEN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-2408
Mailing Address - Country:US
Mailing Address - Phone:803-286-5541
Mailing Address - Fax:803-286-5542
Practice Address - Street 1:1318 HIGHWAY 9 BYP W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4712
Practice Address - Country:US
Practice Address - Phone:803-286-5541
Practice Address - Fax:803-286-5542
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT8452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist