Provider Demographics
NPI:1942756978
Name:DOUGHERTY, BRIAN E (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALTER E FORAN BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4666
Mailing Address - Country:US
Mailing Address - Phone:908-237-0000
Mailing Address - Fax:908-237-0001
Practice Address - Street 1:745 RTE 202/206 STE 303
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1758
Practice Address - Country:US
Practice Address - Phone:908-231-8002
Practice Address - Fax:908-237-8006
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01680700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist