Provider Demographics
NPI:1942574744
Name:COURNOYER, JEFFRY ALAN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:ALAN
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 CAMINO REAL
Mailing Address - Street 2:H220
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7805 CAMINO REAL
Practice Address - Street 2:H220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6800
Practice Address - Country:US
Practice Address - Phone:954-849-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL32382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer