Provider Demographics
NPI:1619353265
Name:DOCHERTY, CARRIE (PHD, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:DOCHERTY
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:DOCHERTY
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, ATC, LAT
Mailing Address - Street 1:1635 N PRAIRIE GREEN CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-8701
Mailing Address - Country:US
Mailing Address - Phone:812-325-8166
Mailing Address - Fax:
Practice Address - Street 1:1025 E 7TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-7109
Practice Address - Country:US
Practice Address - Phone:812-856-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001155A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer