Lisa Marie Dougherty, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT006185 Issued in GA

Practice address

660 Lake Joy Rd Ste D
Kathleen, GA 31047-2382

Phone

(478) 313-5385

NPI assigned

Aug 23, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Wellness Inc

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1972832772
  NPD (past) Authorized official
• Benchmark Physical Therapy, Inc

  • Physical Therapist
  • Lawrenceville, GA
  • NPI 1053564047
  NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  NPD
• Independent Physical Therapy of Georgia, LLC

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  NPD
• Dekalb Comprehensive Physical Therapy Limited Partnership

  • Durable Medical Equipment & Medical Supplies
  • Stonecrest, GA
  • NPI 1639384225
  NPD (past)
• Dekalb Comprehensive Physical Therapy Limited Partnership

  • Physical Therapist
  • Stonecrest, GA
  • NPI 1831136951
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1164538773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "866-518-0283",
            "fax_number": "423-238-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 LAKE JOY RD STE D",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "310472382",
            "telephone_number": "478-313-5385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "511 Gordon Ave",
            "address_purpose": "LOCATION",
            "city": "Thomasville",
            "state": "GA",
            "postal_code": "317926645",
            "country_code": "US",
            "telephone_number": "229-228-9019",
            "fax_number": "229-228-6066",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3315 Sugarloaf Pkwy",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300445497",
            "country_code": "US",
            "telephone_number": "770-316-0601",
            "fax_number": "770-978-6739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT006185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52676665",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000950573A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maureen De Jonge, RN, MA, LPC
• Deanna Moore Consulting Force, LLC
• Brittany Sanders Dickerson
• Jenny Diep, PHARMD
• DME
• Dugan Therapy, Inc
• Sharron Dugan
• Jennifer Nicole Ambre Dyson, APRN
• Chandler Henshaw Edge, COTA/L
• Keith Mwaye Ekwese

• All providers in Kathleen, GA
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.