Provider Demographics
NPI:1548760200
Name:AGUDA-SEMANA, COURTNEY MK (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MK
Last Name:AGUDA-SEMANA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 W CHARLESTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1991
Mailing Address - Country:US
Mailing Address - Phone:702-570-6222
Mailing Address - Fax:702-570-6234
Practice Address - Street 1:3213 W CHARLESTON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1991
Practice Address - Country:US
Practice Address - Phone:702-570-6222
Practice Address - Fax:702-570-6234
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist