Provider Demographics
NPI:1255871422
Name:TSO, COURTNEY GARLOCK (PT, DPT, CERT MDT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GARLOCK
Last Name:TSO
Suffix:
Gender:F
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:65 E WADSWORTH PARK DR STE 230
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8096
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014450225100000X
VT40.0134344225100000X
DCPT200001280225100000X
MD28721225100000X
MA25853225100000X
NJ40QA02055300225100000X
PAPT029943225100000X
RIPT03437225100000X
IL070027634225100000X
MEPT6096225100000X
NH4902225100000X
TX1378615225100000X
AK211531225100000X
CA304552225100000X
NY037815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist