Provider Demographics
NPI:1376771212
Name:WASS-MARTINEAU, COURTNEY REID (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:REID
Last Name:WASS-MARTINEAU
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RAY WAY
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-2573
Mailing Address - Country:US
Mailing Address - Phone:508-456-1005
Mailing Address - Fax:
Practice Address - Street 1:215 THATCHER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3949
Practice Address - Country:US
Practice Address - Phone:508-583-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist