Individual
KIM DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
113 E 23RD ST, NEW YORK, NY 10010-4507
(646) 742-0165
(646) 742-0462
Mailing address
113 E 23RD ST, NEW YORK, NY 10010-4507
(646) 742-0165
(646) 742-0462
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008255-1
NY
Other
Enumeration date
04/09/2019
Last updated
06/11/2019
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