Provider Demographics
NPI:1417237041
Name:HEINZ, COURTNEY JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:JEAN
Last Name:HEINZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2555 PHILLIPS FIELD RD
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3933
Mailing Address - Country:US
Mailing Address - Phone:907-465-5990
Mailing Address - Fax:907-374-2036
Practice Address - Street 1:2555 PHILLIPS FIELD RD
Practice Address - Street 2:STE 202
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3933
Practice Address - Country:US
Practice Address - Phone:907-465-5990
Practice Address - Fax:907-374-2036
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist