Provider Demographics
NPI:1386021632
Name:DAWES HENNINGS, COURTNEY N (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:DAWES HENNINGS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:N
Other - Last Name:DAWES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4257
Mailing Address - Country:US
Mailing Address - Phone:503-540-6300
Mailing Address - Fax:503-540-6404
Practice Address - Street 1:5825 SHOREVIEW LN N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3978
Practice Address - Country:US
Practice Address - Phone:503-540-6471
Practice Address - Fax:503-540-6404
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500687150Medicaid
OR500687150Medicaid