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NPI Code Detail

MEDICARE: COURTNEY NICOLE TEDDER DPT

MEDICARE: COURTNEY NICOLE TEDDER 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
1225100000XPhysical TherapistPTH9850AL

General Provider Information

NPI Number : 1710582507
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY NICOLE TEDDER DPT
Provider Business Mailing Address
First Line : 505 E LAFAYETTE ST
Second Line :
City : MARION
State : AL
Zip : 36756-2323
Country : US
Telephone Number : 334-683-9696
Fax Number : 334-683-9995
Provider Business Practice Location Address
First Line : 505 E LAFAYETTE ST
Second Line :
City : MARION
State : AL
Zip : 36756-2323
Country : US
Telephone Number : 334-683-9696
Fax Number : 334-683-9995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “ COURTNEY NICOLE TEDDER DPT” Practice Location

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