MEDICARE: COURTNEY E SOUTER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305211493	VA

General Provider Information

NPI Number	:	1033637772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY E SOUTER DPT

Provider Business Mailing Address
First Line	:	225 REINEKERS LN STE GR4
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2871
Country	:	US
Telephone Number	:	703-299-3111
Fax Number	:	703-299-1556

Provider Business Practice Location Address
First Line	:	225 REINEKERS LN STE GR4
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2871
Country	:	US
Telephone Number	:	703-299-3111
Fax Number	:	703-299-1556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	09/01/2017

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Directions to “ COURTNEY E SOUTER DPT” Practice Location

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