Provider Demographics
NPI:1861846990
Name:GREEN, COURTNEY (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GREEN
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 1:1716 MEADOWBROOK DR SE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-9563
Mailing Address - Country:US
Mailing Address - Phone:256-708-0329
Mailing Address - Fax:205-543-6910
Practice Address - Street 1:419 MAIN AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3348
Practice Address - Country:US
Practice Address - Phone:256-708-0329
Practice Address - Fax:205-543-6910
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist