Provider Demographics
NPI:1679372890
Name:COURT, CARISSA NICOLE
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:NICOLE
Last Name:COURT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WOODVALE DR
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2920
Mailing Address - Country:US
Mailing Address - Phone:856-685-9281
Mailing Address - Fax:
Practice Address - Street 1:41 WOODVALE DR
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2920
Practice Address - Country:US
Practice Address - Phone:856-685-9281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist