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NPI Code Detail

MEDICARE: COURTNEY PICKEL PT

MEDICARE: COURTNEY PICKEL PT
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
1225100000XPhysical TherapistPT0000004719TN
22251P0200XPediatric Physical TherapistPT0000004719TN
3225100000XPhysical Therapist2305206123VA
42251P0200XPediatric Physical Therapist2305206123VA

General Provider Information

NPI Number : 1194989384
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY PICKEL PT
Provider Business Mailing Address
First Line : 1319 SUNSET DR
Second Line : SUITE 102
City : JOHNSON CITY
State : TN
Zip : 37604-3799
Country : US
Telephone Number : 423-534-8897
Fax Number : 423-328-8662
Provider Business Practice Location Address
First Line : 1319 SUNSET DR
Second Line : SUITE 102
City : JOHNSON CITY
State : TN
Zip : 37604-3799
Country : US
Telephone Number : 423-534-8897
Fax Number : 423-328-8662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2008
Last Update Date : 01/12/2015

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Directions to “ COURTNEY PICKEL PT” Practice Location

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