Provider Demographics
NPI:1518356047
Name:BRANTLEY, COURTNEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:MORGAN
Other - Last Name:BRANTLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1001 JAMERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-2619
Mailing Address - Country:US
Mailing Address - Phone:903-736-8409
Mailing Address - Fax:
Practice Address - Street 1:1001 JAMERSON RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693-2619
Practice Address - Country:US
Practice Address - Phone:903-736-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2056173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant