Individual
PHILLIP D. COURTNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18708 SUE TAWN DRIVE, CHUGIAK, AK 99567
(907) 688-0731
Mailing address
PO BOX 670811, CHUGIAK, AK 99567-0811
(907) 688-0731
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
171WH0202X
Home Modifications Contractor
Primary
24301
AK
171WV0202X
Vehicle Modifications Contractor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EM4435
—
AK
Enumeration date
02/21/2012
Last updated
02/21/2012
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