MEDICARE: DR. COURTNEY LONG 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	15341-24	WI

General Provider Information

NPI Number	:	1437638152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY LONG PT, DPT

Provider Business Mailing Address
First Line	:	2105 E ENTERPRISE AVE STE 113
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7862
Country	:	US
Telephone Number	:	920-991-2561
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 LIME KILN RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-6213
Country	:	US
Telephone Number	:	605-697-9500
Fax Number	:

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

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	01/16/2026

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