Provider Demographics
NPI:1780025783
Name:POWELL, COURTNEY ANN MARIE (ATC, AT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:ATC, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4237
Mailing Address - Country:US
Mailing Address - Phone:937-789-7407
Mailing Address - Fax:
Practice Address - Street 1:7677 YANKEE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-401-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0033812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer