Provider Demographics
NPI:1669458220
Name:DOUGHER, ROBERT L (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:DOUGHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3665 S 8400 W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-2214
Mailing Address - Country:US
Mailing Address - Phone:801-250-6733
Mailing Address - Fax:801-250-5038
Practice Address - Street 1:3665 S 8400 W
Practice Address - Street 2:SUITE 210
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-2214
Practice Address - Country:US
Practice Address - Phone:801-250-6733
Practice Address - Fax:801-250-5038
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5165580-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005803401Medicare PIN
UTP70291Medicare UPIN