Provider Demographics
NPI:1811062466
Name:MATTES, COURTNEY OWEN (DPT)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:OWEN
Last Name:MATTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10933 GRANADA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3607
Mailing Address - Country:US
Mailing Address - Phone:804-320-6399
Mailing Address - Fax:
Practice Address - Street 1:1300 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2604
Practice Address - Country:US
Practice Address - Phone:804-378-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist