Individual
MARK S DAUGHERITY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
201 E 2ND ST, SUITE 14, CASPER, WY 82601-2582
(307) 337-1624
Mailing address
201 E 2ND ST, SUITE 14, CASPER, WY 82601-2582
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-0500
WY
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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