Provider Demographics
NPI:1831523778
Name:TAGGART, COURTNEY SUE (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SUE
Last Name:TAGGART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:SUE
Other - Last Name:TAGGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3236 STATE HWY 257 SUITE 1
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:202 UNION ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1166
Practice Address - Country:US
Practice Address - Phone:814-827-8148
Practice Address - Fax:814-827-0349
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022828225100000X
NC14539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102984905 0005Medicaid
NC848HOtherBCBS
PA102984905 0005Medicaid
NC848HOtherBCBS