Provider Demographics
NPI:1508096355
Name:IVERSON, COURTNEY LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYNN
Last Name:IVERSON
Suffix:
Gender:F
Credentials:DPT
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 693
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-0693
Mailing Address - Country:US
Mailing Address - Phone:802-878-6656
Mailing Address - Fax:802-878-6099
Practice Address - Street 1:70 MARSHALL AVE
Practice Address - Street 2:#201
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8939
Practice Address - Country:US
Practice Address - Phone:802-878-6656
Practice Address - Fax:802-878-6099
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400050773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist