Provider Demographics
NPI:1730675885
Name:DOUTHARD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DOUTHARD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, PT
Authorized Official - Phone:417-230-1662
Mailing Address - Street 1:460 HIGHPOINTS RDG
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7814
Mailing Address - Country:US
Mailing Address - Phone:417-230-1662
Mailing Address - Fax:
Practice Address - Street 1:714 STATE HIGHWAY 248 STE 503
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3761
Practice Address - Country:US
Practice Address - Phone:417-230-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002291261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy