Connor James Dougherty, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60858127 Issued in WA

Practice address

110 110TH Ave NE Ste 110
Bellevue, WA 98004-5840

Phone

(425) 628-2072

Fax

(425) 341-9056

NPI assigned

Aug 7, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Massachusetts Physical Therapy and Wellness LLCGroup PAC ID 6507903481, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Central Massachusetts Physical Therapy and Wellness, LLC

  • Physical Therapy Clinic/Center
  • West Boylston, MA
  • NPI 1023214871

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533600000000",
    "number": "1396224853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 132ND ST SE STE 101",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980128999",
            "telephone_number": "425-686-7658",
            "fax_number": "425-341-9034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 110TH AVE NE STE 110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980045840",
            "telephone_number": "425-628-2072",
            "fax_number": "425-341-9056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "CONNOR",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-07",
        "last_updated": "2018-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60858127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Laura Johnson
• Zachary C Dorsett
• Joseph W Doucette, M.D.
• Doug Bartholomew Ms Inc.
• Keivencia Pelia Anne Myrtel Douge
• Kendall Dougherty, OTR/L
• Maryellen Dougherty
• Claire Douglas, OT
• Molly Douglas
• Akilina Douthat, LMT

• Physical Therapist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.