Provider Demographics
NPI:1710656228
Name:COLLIER, COURTNEY K (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:K
Last Name:COLLIER
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 1:105 BONNER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7458
Mailing Address - Country:US
Mailing Address - Phone:225-252-5059
Mailing Address - Fax:
Practice Address - Street 1:418 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4971
Practice Address - Country:US
Practice Address - Phone:337-839-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist