Provider Demographics
NPI:1700903127
Name:DOUGHERTY, DEEANN ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:DEEANN
Middle Name:ELIZABETH
Last Name:DOUGHERTY
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 1:17120 PILKINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5353
Mailing Address - Country:US
Mailing Address - Phone:503-768-9873
Mailing Address - Fax:503-974-9083
Practice Address - Street 1:17120 PILKINGTON RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5353
Practice Address - Country:US
Practice Address - Phone:503-768-9873
Practice Address - Fax:503-974-9083
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11772251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic