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General NPI Number Information
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NPI Number | 1831782820
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Entity Type | Individual
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Provider Name | COURTNEY KLUSEK
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Gender | Female
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 14557 W INDIAN SCHOOL RD
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City | GOODYEAR
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State | AZ
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Zip | 85395-9243
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Country | US
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Telephone | 623-242-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 12813 W ALVARADO RD
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City | AVONDALE
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State | AZ
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Zip | 85392-7053
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Country | US
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Telephone | 602-639-1572
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 31618
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License Number State | AZ
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