Provider Demographics
NPI:1376007153
Name:WEARS, COURTNEY SHANE (ATC)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:SHANE
Last Name:WEARS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28600 TORCH RD
Mailing Address - Street 2:
Mailing Address - City:COOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45723-9024
Mailing Address - Country:US
Mailing Address - Phone:740-860-1278
Mailing Address - Fax:
Practice Address - Street 1:28600 TORCH RD
Practice Address - Street 2:
Practice Address - City:COOLVILLE
Practice Address - State:OH
Practice Address - Zip Code:45723-9024
Practice Address - Country:US
Practice Address - Phone:740-860-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner