Healthcare Provider Details

I. General information

NPI: 1134430796
Provider Name (Legal Business Name): COURTNEY LYNN DENK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 SHADOWDALE DR
HOUSTON TX
77041-8718
US

IV. Provider business mailing address

4423 SHADOWDALE LN
HOUSTON TX
77041-8718
US

V. Phone/Fax

Practice location:
  • Phone: 713-466-6872
  • Fax: 713-466-9547
Mailing address:
  • Phone: 713-466-6872
  • Fax: 713-466-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1198410
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: