Provider Demographics
NPI:1417162777
Name:PAVLOVICH, COURTNEY JOANNE (LPTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JOANNE
Last Name:PAVLOVICH
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25818-0111
Mailing Address - Country:US
Mailing Address - Phone:304-237-4755
Mailing Address - Fax:
Practice Address - Street 1:159 SEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2315
Practice Address - Country:US
Practice Address - Phone:803-329-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2055225200000X
PATE007738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant