Provider Demographics
NPI:1992472823
Name:VANWIE, COURTNEY PATRICIA (DPT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PATRICIA
Last Name:VANWIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 GEORGE C MARSHALL DR APT 901
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2580
Mailing Address - Country:US
Mailing Address - Phone:410-294-4622
Mailing Address - Fax:
Practice Address - Street 1:6733 CURRAN ST STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6032
Practice Address - Country:US
Practice Address - Phone:703-448-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist