Provider Demographics
NPI:1902363872
Name:GARR, COURTNEY ELIZABETHANN (DPT PT)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELIZABETHANN
Last Name:GARR
Suffix:
Gender:F
Credentials:DPT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:STOVER
Mailing Address - State:MO
Mailing Address - Zip Code:65078-0907
Mailing Address - Country:US
Mailing Address - Phone:573-489-9714
Mailing Address - Fax:
Practice Address - Street 1:1714 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5273
Practice Address - Country:US
Practice Address - Phone:660-827-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019003959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist