Provider Demographics
NPI:1063570935
Name:COURTIAL, DONALD CLAY (PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CLAY
Last Name:COURTIAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:9 OAK KNOLL PLACE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1817
Mailing Address - Country:US
Mailing Address - Phone:618-398-0188
Mailing Address - Fax:618-257-6929
Practice Address - Street 1:REHABILITATION SERVICES MOMORIAL HOSPITAL
Practice Address - Street 2:4500 MEMORIAL DRIVE
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-257-5254
Practice Address - Fax:618-257-6929
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist