Provider Demographics
NPI:1063451581
Name:DOUGHERTY, DENNIS JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOSEPH
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20687
Mailing Address - Street 2:ST LUKES PHYSICAL THERAPY
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0687
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:1321 W BROAD STREET
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1107
Practice Address - Country:US
Practice Address - Phone:215-538-9560
Practice Address - Fax:215-538-1051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002897L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50037200OtherCAPITAL
PA0460742OtherHIGHMARK
PA50037200OtherCAPITAL