Provider Demographics
NPI:1518977248
Name:BEMIS-DOUGHERTY, ANITA (PT, DPT, MAS)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:BEMIS-DOUGHERTY
Suffix:
Gender:F
Credentials:PT, DPT, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FARM RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9781
Mailing Address - Country:US
Mailing Address - Phone:410-733-3626
Mailing Address - Fax:410-592-3398
Practice Address - Street 1:8 FARM RIDGE CT
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MD
Practice Address - Zip Code:21013-9781
Practice Address - Country:US
Practice Address - Phone:410-733-3626
Practice Address - Fax:410-592-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14396225100000X
VA2305204627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist