Provider Demographics
NPI:1154632263
Name:DOUGHTY, JAMES CHRISTOPHER (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:DOUGHTY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 STATE ROUTE 315
Mailing Address - Street 2:
Mailing Address - City:DEANSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13328-1324
Mailing Address - Country:US
Mailing Address - Phone:315-841-4777
Mailing Address - Fax:
Practice Address - Street 1:1601 ARMORY DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5405
Practice Address - Country:US
Practice Address - Phone:315-798-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002538-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant