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NPI Code Detail

MEDICARE: MS. COURTNEY RAE DEJONG DPT

MEDICARE: MS. COURTNEY RAE DEJONG DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist11-04595KS

General Provider Information

NPI Number : 1619317609
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COURTNEY RAE DEJONG DPT
Provider Business Mailing Address
First Line : 234 W GREENWAY ST
Second Line :
City : DERBY
State : KS
Zip : 67037-2641
Country : US
Telephone Number : 316-788-6734
Fax Number : 316-788-4529
Provider Business Practice Location Address
First Line : 234 W GREENWAY ST
Second Line :
City : DERBY
State : KS
Zip : 67037-2641
Country : US
Telephone Number : 316-788-6734
Fax Number : 316-788-4529
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2013
Last Update Date : 11/29/2017

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Directions to “ MS. COURTNEY RAE DEJONG DPT” Practice Location

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