Individual
MR. KEVIN PATRICK DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
14825 N OUTER FORTY ROAD, SUITE 300, CHESTERFIELD, MO 63005-0002
(636) 812-1211
(636) 812-0159
Mailing address
13537 BARRETT PARKWAY DRIVE, SUITE 105, BALLWIN, MO 63021-5866
(314) 821-9126
(314) 821-9142
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2006009447
MO
Other
Enumeration date
06/10/2006
Last updated
05/11/2010
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