Healthcare Provider Details

I. General information

NPI: 1487136487
Provider Name (Legal Business Name): COURTNEY R MICHEL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LARSON

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S ALABAMA ST
INDIANAPOLIS IN
46225-3301
US

IV. Provider business mailing address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-2489
  • Fax:
Mailing address:
  • Phone: 317-528-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013003A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: