Provider Demographics
NPI:1598077695
Name:COURTNEY, PATRICIA MONIQUE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MONIQUE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 173RD PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-2847
Mailing Address - Country:US
Mailing Address - Phone:425-238-1700
Mailing Address - Fax:
Practice Address - Street 1:16825 48TH AVE W
Practice Address - Street 2:SUITE 449
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6401
Practice Address - Country:US
Practice Address - Phone:425-238-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist