Provider Demographics
NPI:1740944925
Name:VANDERMAY, COURTNEY VIOLET (DPT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:VIOLET
Last Name:VANDERMAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5539
Mailing Address - Country:US
Mailing Address - Phone:201-790-3697
Mailing Address - Fax:
Practice Address - Street 1:2268 N LAKE SHORE DR STE 106
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-0280
Practice Address - Country:US
Practice Address - Phone:973-979-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32248225100000X
TN14700225100000X
NCP20807225100000X
NJ40QA02047300225100000X
MA26167225100000X
TX1374080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist