Provider Demographics
NPI:1013024645
Name:DAUGHERTY, ALLYSON H (PT, CLT, CFM)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:H
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:PT, CLT, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GREENVILLE BLVD SE
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-215-5225
Mailing Address - Fax:252-215-5226
Practice Address - Street 1:308 GREENVILLE BLVD SE
Practice Address - Street 2:SUITE B-3
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5758
Practice Address - Country:US
Practice Address - Phone:252-215-5225
Practice Address - Fax:252-215-5226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6258110001Medicare NSC