Provider Demographics
NPI:1538789698
Name:DEVEREUX, COURTNEY R
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:R
Last Name:DEVEREUX
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 1:2202 VALLEY BLOSSUM LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3977
Mailing Address - Country:US
Mailing Address - Phone:832-315-1614
Mailing Address - Fax:
Practice Address - Street 1:2202 VALLEY BLOSSUM LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3977
Practice Address - Country:US
Practice Address - Phone:832-315-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer