Provider Demographics
NPI:1487044558
Name:WAYLAND, COURTNEY C (PT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:C
Last Name:WAYLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 ARROWSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9600
Mailing Address - Country:US
Mailing Address - Phone:907-982-2798
Mailing Address - Fax:502-899-4719
Practice Address - Street 1:6008 BROWNSBORO PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1295
Practice Address - Country:US
Practice Address - Phone:502-899-4760
Practice Address - Fax:502-899-4719
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK220240225100000X
KY004056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist