Provider Demographics
NPI:1912283003
Name:COURNEY, LYDIA
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:
Last Name:COURNEY
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 1:701 W ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-9561
Mailing Address - Country:US
Mailing Address - Phone:360-461-3721
Mailing Address - Fax:
Practice Address - Street 1:701 W ANDERSON RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-9561
Practice Address - Country:US
Practice Address - Phone:360-461-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38328Medicaid
CA38328Medicare PIN