Provider Demographics
NPI:1104574144
Name:VAN DEUTSCH, CORTLYN (DPT)
Entity type:Individual
Prefix:
First Name:CORTLYN
Middle Name:
Last Name:VAN DEUTSCH
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 1:1300 CORPORATION PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1362
Mailing Address - Country:US
Mailing Address - Phone:919-917-7729
Mailing Address - Fax:919-400-4178
Practice Address - Street 1:1300 CORPORATION PKWY STE B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1362
Practice Address - Country:US
Practice Address - Phone:919-917-7729
Practice Address - Fax:919-400-4178
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist