Provider Demographics
NPI:1629232376
Name:COURAGE, PHEDETTE (CRT)
Entity Type:Individual
Prefix:
First Name:PHEDETTE
Middle Name:
Last Name:COURAGE
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 SW 256TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6925
Mailing Address - Country:US
Mailing Address - Phone:305-910-5460
Mailing Address - Fax:
Practice Address - Street 1:335 S KROME AVE
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-4906
Practice Address - Country:US
Practice Address - Phone:305-242-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT137682278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTT 13768OtherRESPIRATORY THERAPY