Provider Demographics
NPI:1952629669
Name:DOUGAN, LORETTA (PT DPT)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:DOUGAN
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W STOCKHOLM SOUTHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3361
Mailing Address - Country:US
Mailing Address - Phone:315-323-3376
Mailing Address - Fax:
Practice Address - Street 1:16 W STOCKHOLM SOUTHVILLE RD
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3361
Practice Address - Country:US
Practice Address - Phone:315-323-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024550-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health