Individual
PATRICK DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2301 S STATE ROUTE 291, INDEPENDENCE, MO 64057-1201
(816) 373-9328
Mailing address
3808 S HOWELL RD, OAK GROVE, MO 64075-7177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116482
LICENSE #
MO
Enumeration date
08/30/2006
Last updated
07/08/2007
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