Provider Demographics
NPI:1760587091
Name:DAUGHERTY, CARIE CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:CHRISTINE
Last Name:DAUGHERTY
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 1:740 EAST WASHINGTON AVENUE
Mailing Address - Street 2:SUITE E4
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2136
Mailing Address - Country:US
Mailing Address - Phone:330-722-3781
Mailing Address - Fax:330-725-6294
Practice Address - Street 1:740 EAST WASHINGTON AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2136
Practice Address - Country:US
Practice Address - Phone:330-722-3781
Practice Address - Fax:330-725-6294
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist