Kim Dougherty, PTA
Physical Therapy Assistant in New York, NY. Individual provider (NPI-1).
NPI number1154884906
StatusActive
Last updated in NPPESJun 11, 2019
Details
- NPI
- 1154884906
- Entity type
- Individual (NPI-1)
- Name
- Kim Dougherty
- Credential
- PTA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 9, 2019
- Last updated
- Jun 11, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | 008255-1 | NY | Yes |
Practice location
113 E 23rd StNew York, NY 10010-4507
Phone 646-742-0165 · Fax 646-742-0462
Mailing address
113 E 23rd StNew York, NY 10010-4507
Phone 646-742-0165 · Fax 646-742-0462
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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