Provider Demographics
NPI:1881347375
Name:DOUGHERTY, KASEY (DPT)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:1025 SE TALLGRASS LN STE 120
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-6817
Practice Address - Country:US
Practice Address - Phone:515-875-9706
Practice Address - Fax:515-875-9707
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist