Provider Demographics
NPI:1740046606
Name:SANDELL, COURTNEY S (PT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:S
Last Name:SANDELL
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 1:6320 N 70TH PLAZA
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1072
Mailing Address - Country:US
Mailing Address - Phone:402-573-3761
Mailing Address - Fax:402-573-3780
Practice Address - Street 1:732-734 MO-7
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64104
Practice Address - Country:US
Practice Address - Phone:816-229-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4592225100000X
MO4592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist