Provider Demographics
NPI:1669840732
Name:FREDERICK, COURTNEY (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:FREDERICK
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 356
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0356
Mailing Address - Country:US
Mailing Address - Phone:301-421-1125
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-681-7880
Practice Address - Fax:301-500-2715
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024665225100000X
MD25658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist