MEDICARE: COURTNEY MAUTZ

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	225200000X	Physical Therapy Assistant	09045	OH

General Provider Information

NPI Number	:	1588045595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MAUTZ

Provider Business Mailing Address
First Line	:	6200 TOWNSHIP ROAD 32 NW
Second Line	:
City	:	SOMERSET
State	:	OH
Zip	:	43783-9634
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 TOWNSHIP ROAD 32 NW
Second Line	:
City	:	SOMERSET
State	:	OH
Zip	:	43783-9634
Country	:	US
Telephone Number	:	740-408-4471
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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Directions to “ COURTNEY MAUTZ ” Practice Location

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