Provider Demographics
NPI:1497865158
Name:RICHARD, COURTNEY (PTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:RICHARD
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 1:2901 SW 41ST ST
Mailing Address - Street 2:APT 1114
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7449
Mailing Address - Country:US
Mailing Address - Phone:850-699-8563
Mailing Address - Fax:
Practice Address - Street 1:5481 SW 41ST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-873-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA20238OtherLICENSE #