Provider Demographics
NPI:1629859830
Name:DOUGHERTY, KARLEY THERESA (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:KARLEY
Middle Name:THERESA
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GRAND BAYOU PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1624
Mailing Address - Country:US
Mailing Address - Phone:330-618-7098
Mailing Address - Fax:
Practice Address - Street 1:27 GRAND BAYOU PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1624
Practice Address - Country:US
Practice Address - Phone:330-618-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13475062081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine