Provider Demographics
NPI:1194989384
Name:PICKEL, COURTNEY (PT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PICKEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 SUNSET DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3799
Mailing Address - Country:US
Mailing Address - Phone:423-534-8897
Mailing Address - Fax:423-328-8662
Practice Address - Street 1:1319 SUNSET DR
Practice Address - Street 2:SUITE 102
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3799
Practice Address - Country:US
Practice Address - Phone:423-534-8897
Practice Address - Fax:423-328-8662
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000004719225100000X, 2251P0200X
VA2305206123225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist