Provider Demographics
NPI:1467275958
Name:DOUGHER, TAMARA ROSILA (LPTA)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ROSILA
Last Name:DOUGHER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 BEARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6602
Mailing Address - Country:US
Mailing Address - Phone:570-575-0662
Mailing Address - Fax:
Practice Address - Street 1:4142 BEARBROOK RD
Practice Address - Street 2:
Practice Address - City:MADISON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-6602
Practice Address - Country:US
Practice Address - Phone:570-575-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant