Provider Demographics
NPI:1154996403
Name:MASON, COURTNEY LEIGH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LEIGH
Last Name:MASON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:MASON
Other - Last Name:COWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:200 GRACE LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9098
Mailing Address - Country:US
Mailing Address - Phone:720-629-7139
Mailing Address - Fax:
Practice Address - Street 1:132 SOUTHLAND DR # 1A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1924
Practice Address - Country:US
Practice Address - Phone:859-523-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0082512251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic