Provider Demographics
NPI:1407624646
Name:VAN SCHOONHOVEN, CORTNI (DPT)
Entity Type:Individual
Prefix:
First Name:CORTNI
Middle Name:
Last Name:VAN SCHOONHOVEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CORTNI
Other - Middle Name:SUE
Other - Last Name:ENSIGN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6050 TACOMA MALL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17307 SE 272ND ST STE 142
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5330
Practice Address - Country:US
Practice Address - Phone:253-243-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60164421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist