Provider Demographics
NPI:1821229980
Name:VANDERSTOCK, COURTNEY (CMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:VANDERSTOCK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 S BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5631
Mailing Address - Country:US
Mailing Address - Phone:303-683-3377
Mailing Address - Fax:303-683-1453
Practice Address - Street 1:9299 S BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-5631
Practice Address - Country:US
Practice Address - Phone:303-683-3377
Practice Address - Fax:303-683-1453
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist