Individual
COURTNEY JEWEL BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC
Contact information
Practice address
1500 E FAIRVIEW AVE # 461, MONTGOMERY, AL 36106-2114
(469) 525-5710
Mailing address
1504 PECAN VALLEY DR, MCKINNEY, TX 75072-8323
(469) 525-5710
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
AT9476
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477277523
NPI
TX
Enumeration date
10/03/2022
Last updated
06/26/2024
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