Provider Demographics
NPI:1386276327
Name:PELLEGRIN, COURTNEY LEIGH
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:PELLEGRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MATHEW ST
Mailing Address - Street 2:
Mailing Address - City:LAFITTE
Mailing Address - State:LA
Mailing Address - Zip Code:70067-5117
Mailing Address - Country:US
Mailing Address - Phone:504-628-9075
Mailing Address - Fax:
Practice Address - Street 1:533 MATHEW ST
Practice Address - Street 2:
Practice Address - City:LAFITTE
Practice Address - State:LA
Practice Address - Zip Code:70067-5117
Practice Address - Country:US
Practice Address - Phone:504-628-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer