Individual
TYLER DOUGHTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1213 ANNIS AVE, MATTOON, IL 61938-6016
(217) 246-7963
Mailing address
1213 ANNIS AVE, MATTOON, IL 61938-6016
(217) 246-7963
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.006046
IL
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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