Provider Demographics
NPI:1437523917
Name:TRAMMELL, COURTNEY LANELLE (PTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LANELLE
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3836
Mailing Address - Country:US
Mailing Address - Phone:479-782-1444
Mailing Address - Fax:479-782-1477
Practice Address - Street 1:314 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3836
Practice Address - Country:US
Practice Address - Phone:479-782-1444
Practice Address - Fax:479-782-1477
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR211506721Medicaid