Provider Demographics
NPI:1942274386
Name:DOUGHTY, MARK PAUL (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PAUL
Last Name:DOUGHTY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:350 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4539
Mailing Address - Country:US
Mailing Address - Phone:740-366-5718
Mailing Address - Fax:740-349-2313
Practice Address - Street 1:314 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4483
Practice Address - Country:US
Practice Address - Phone:740-328-2228
Practice Address - Fax:740-349-2313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAT-0000042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer