Provider Demographics
NPI:1124518444
Name:COURTENAY, DANIEL (MPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:COURTENAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12261 HIGHWAY 49 STE 1
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2976
Mailing Address - Country:US
Mailing Address - Phone:228-860-9676
Mailing Address - Fax:228-860-9676
Practice Address - Street 1:12261 HIGHWAY 49 STE 1
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2976
Practice Address - Country:US
Practice Address - Phone:228-860-9676
Practice Address - Fax:228-860-9676
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist