MEDICARE: CORTNEY ELOISE VANMETER PT, 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	4036	AR

General Provider Information

NPI Number	:	1134843774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORTNEY ELOISE VANMETER PT, DPT

Provider Business Mailing Address
First Line	:	1811 E MAIN ST
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9254
Country	:	US
Telephone Number	:	479-970-6977
Fax Number	:	479-662-4766

Provider Business Practice Location Address
First Line	:	1811 E MAIN ST
Second Line	:
City	:	CHARLESTON
State	:	AR
Zip	:	72933-9254
Country	:	US
Telephone Number	:	479-970-6977
Fax Number	:	479-662-4766

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

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	02/15/2023

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