Joseph Dougherty III, PTA
Individual provider Active NPI Physical Therapy Assistant · Hazle Township, PA
NPI 1023447604 · NPPES record last updated Nov 5, 2013
Key facts
- NPI
- 1023447604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- TE1003543 (PA)
- Practice address
- 401 Hazle Township Blvd
Hazle Township, PA 18202-9661 - Phone
- (570) 454-8888
- NPI assigned
- Nov 5, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE1003543 | PA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berwick Clinic Company LLC | Past | Accepting new patients | |
| Advanced Inpatient Medicine Transitional Care PC | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/1704/brand/1/csg/81/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | TE1003543 | PA | Yes |
Addresses
Primary practice location
401 Hazle Township Blvd
Hazle Township, PA 18202-9661
Mailing address
401 Hazle Township Blvd
Hazle Township, PA 18202-9661
Phone (570) 454-8888
Other providers in Hazle Township, PA
- James Deom
- Digital Hearing Aid Systems, Inc
- Tracey Marie Dixon
- Jennifer Domzalski
- Dane J Doornbos
- Victoria Rose Downey
- Dr Sandra M Krokos & Thomas P Kislan PC
- Hailey Dwyer
- Eagle Optometric PC
- Rhina Elliot
All providers in Hazle Township, PA · Physical Therapy Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.