Individual
COURTNEY BOUTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2850 PORTERS CHAPEL RD, VICKSBURG, MS 39180-1805
(601) 638-9211
(601) 636-4986
Mailing address
2850 PORTERS CHAPEL RD, VICKSBURG, MS 39180-1805
(601) 638-9211
(601) 636-4986
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4744
MS
Other
Enumeration date
10/07/2010
Last updated
10/07/2010
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