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NPI Code Detail

MEDICARE: MISS COURTNEY ANNE EARGLE ATC

MEDICARE: MISS COURTNEY ANNE EARGLE ATC
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
1246Z00000XOther Specialist/Technologist2000023177CA

General Provider Information

NPI Number : 1063953826
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS COURTNEY ANNE EARGLE ATC
Provider Business Mailing Address
First Line : 1905 MAIN ST
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2705
Country : US
Telephone Number : 760-553-3116
Fax Number :
Provider Business Practice Location Address
First Line : 1905 MAIN ST
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2705
Country : US
Telephone Number : 760-553-3116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2017
Last Update Date : 03/13/2017

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Directions to “ MISS COURTNEY ANNE EARGLE ATC” Practice Location

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