Provider Demographics
NPI:1548209067
Name:DOUGHERTY, JUDITH A (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:DOUGHERTY
Suffix:
Gender:F
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 3340
Mailing Address - Street 2:NEW VALLEY REHAB
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18043-3340
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:518 CHESTNUT STREET
Practice Address - Street 2:REHAB PARTNERS
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2404
Practice Address - Country:US
Practice Address - Phone:610-967-0770
Practice Address - Fax:610-966-6105
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
PAPT002880L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103124OtherPERSONAL CHOICE IBC
PA50018509OtherCAPITAL
0349217000OtherKEYSTONE
PA01641163Medicaid
0349217000OtherKEYSTONE