Provider Demographics
NPI:1700073087
Name:SPIVEY, COURTNEY ANN (PT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NICKEL ST
Mailing Address - Street 2:STE 6
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2097
Mailing Address - Country:US
Mailing Address - Phone:303-460-9219
Mailing Address - Fax:
Practice Address - Street 1:300 NICKEL ST
Practice Address - Street 2:STE 6
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2097
Practice Address - Country:US
Practice Address - Phone:303-460-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist