Provider Demographics
NPI:1588264238
Name:ALTMAIER, COURTNEY (LMT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ALTMAIER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 S SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49719-9564
Mailing Address - Country:US
Mailing Address - Phone:906-322-6585
Mailing Address - Fax:
Practice Address - Street 1:1175 S SMITH RD
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:MI
Practice Address - Zip Code:49719-9564
Practice Address - Country:US
Practice Address - Phone:906-322-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist