Provider Demographics
NPI:1982988622
Name:BRACKEEN, COURTNEY SHEA (ATC/LAT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SHEA
Last Name:BRACKEEN
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SANDERS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8545
Mailing Address - Country:US
Mailing Address - Phone:731-695-5841
Mailing Address - Fax:
Practice Address - Street 1:437 SANDERS BLUFF RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-8545
Practice Address - Country:US
Practice Address - Phone:731-695-5841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer