Healthcare Provider Details

I. General information

NPI: 1477213338
Provider Name (Legal Business Name): COURTNEY E CORTEZ ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 HARMS RD
JOLIET IL
60435-9044
US

IV. Provider business mailing address

951 ESSINGTON RD
JOLIET IL
60435-8439
US

V. Phone/Fax

Practice location:
  • Phone: 815-474-8002
  • Fax:
Mailing address:
  • Phone: 815-744-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: