Provider Demographics
NPI:1508370479
Name:LEWIS, COURTNEY MCCORMICK (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MCCORMICK
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:5860 COWELL RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-5111
Mailing Address - Country:US
Mailing Address - Phone:734-478-3499
Mailing Address - Fax:
Practice Address - Street 1:5860 COWELL RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-5111
Practice Address - Country:US
Practice Address - Phone:734-478-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010014492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer