Provider Demographics
NPI:1376110833
Name:HARBOUR-NORDAHL, COURTNEY (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HARBOUR-NORDAHL
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 1:12627 E CENTRAL AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2839
Mailing Address - Country:US
Mailing Address - Phone:316-260-3311
Mailing Address - Fax:
Practice Address - Street 1:2757 S SENECA ST STE B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-2862
Practice Address - Country:US
Practice Address - Phone:316-440-3731
Practice Address - Fax:316-440-3741
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KS11-06794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist