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Individual
MRS. MARYELLEN DOUGHERTY
Active
Individual
MRS. MARYELLEN DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT018385
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1928216
BC/BS PIN
PA
01
—
2799524000
KEYSTONE PIN
PA
01
—
P00430771
MEDICARE RAILROAD PIN
PA
Enumeration date
10/13/2006
Last updated
04/05/2011
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