Provider Demographics
NPI:1780451336
Name:SCHOLLIAN, COURTNEY LYNN POWELL
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN POWELL
Last Name:SCHOLLIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PARK CENTER DR APT 414
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1440
Mailing Address - Country:US
Mailing Address - Phone:540-532-5798
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 205
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5365
Practice Address - Country:US
Practice Address - Phone:410-823-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NCP23552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program