Provider Demographics
NPI:1528696903
Name:ELIOTT, COURTNEY (MA42392)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ELIOTT
Suffix:
Gender:F
Credentials:MA42392
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 E ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2246
Mailing Address - Country:US
Mailing Address - Phone:863-398-2470
Mailing Address - Fax:
Practice Address - Street 1:1790 A1A HWY STE 206
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-5440
Practice Address - Country:US
Practice Address - Phone:863-398-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42392OtherMASSAGE THERAPIST