Healthcare Provider Details

I. General information

NPI: 1578257531
Provider Name (Legal Business Name): AMY COURTNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 MAIN ST STE 2
PEEKSKILL NY
10566-2988
US

IV. Provider business mailing address

8400 CLARK MILLS RD
WHITESBORO NY
13492-3005
US

V. Phone/Fax

Practice location:
  • Phone: 716-867-4097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: