Provider Demographics
NPI:1184690067
Name:DOUGHTY, JEFFREY ALLEN (DPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:DOUGHTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 36TH AVE N
Mailing Address - Street 2:STE 140 RATTRAY REHAB PHYSICAL THERAPY
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446
Mailing Address - Country:US
Mailing Address - Phone:763-546-0003
Mailing Address - Fax:763-525-1035
Practice Address - Street 1:15650 36TH AVE N
Practice Address - Street 2:STE 140 RATTRAY REHAB PHYSICAL THERAPY
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446
Practice Address - Country:US
Practice Address - Phone:763-546-0003
Practice Address - Fax:763-525-1035
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7570174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist