Provider Demographics
NPI:1316246481
Name:COURTENAY, ROBERT (LMT, RMT, NCTMB)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:COURTENAY
Suffix:
Gender:M
Credentials:LMT, RMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5036 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3310
Mailing Address - Country:US
Mailing Address - Phone:407-601-4036
Mailing Address - Fax:407-601-4036
Practice Address - Street 1:5036 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 375
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3310
Practice Address - Country:US
Practice Address - Phone:407-601-4036
Practice Address - Fax:407-601-4036
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist