Provider Demographics
NPI:1720387376
Name:YOGUS, COURTNEY MALONE (PT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MALONE
Last Name:YOGUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1008 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1118
Mailing Address - Country:US
Mailing Address - Phone:814-696-1289
Mailing Address - Fax:
Practice Address - Street 1:1798 PLANK RD STE 103
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8389
Practice Address - Country:US
Practice Address - Phone:814-696-3400
Practice Address - Fax:814-696-3402
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013659L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396797Medicare Oscar/Certification