Healthcare Provider Details

I. General information

NPI: 1891600714
Provider Name (Legal Business Name): COURTNEY COURSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 25TH ST STE 420
NORFOLK VA
23508-2386
US

IV. Provider business mailing address

6122 POWHATAN AVE
NORFOLK VA
23508-1014
US

V. Phone/Fax

Practice location:
  • Phone: 877-399-3746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305209954
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: