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Individual
MS. MARY BETH DORGAN
Active
Individual
MS. MARY BETH DORGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
003732
CT
225100000X
Physical Therapist
Primary
9791
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003732
CTPT LICENSE NUMBER
CT
01
—
079PA
BCBS
NC
01
—
9791
NCPT LICENSE NUMBER
NC
Enumeration date
09/25/2006
Last updated
07/08/2007
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