Provider Demographics
NPI:1225406572
Name:DOCHERTY, MOIRA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:
Last Name:DOCHERTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W WILSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1586
Mailing Address - Country:US
Mailing Address - Phone:949-631-0125
Mailing Address - Fax:949-631-0127
Practice Address - Street 1:129 W WILSON ST STE 202
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1586
Practice Address - Country:US
Practice Address - Phone:949-631-0125
Practice Address - Fax:949-631-0127
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist