Healthcare Provider Details

I. General information

NPI: 1194368712
Provider Name (Legal Business Name): COURTNEY FRIESE MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY FRIESE MS, LAT, ATC

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 SCHOOL LN
UPPER MARLBORO MD
20772-2866
US

IV. Provider business mailing address

16002 ENGLISH OAKS AVE APT K
BOWIE MD
20716-3338
US

V. Phone/Fax

Practice location:
  • Phone: 301-952-6000
  • Fax:
Mailing address:
  • Phone: 717-414-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA0000960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: