Individual
PAUL DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3715 THATCHER AVE, PUEBLO, CO 81005-1255
(719) 470-2281
Mailing address
3715 THATCHER AVE, PUEBLO, CO 81005-1255
(719) 470-2281
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0015015
CO
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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