Maryellen Dougherty, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT018385 Issued in PA

Practice address

203 E Baltimore Pike
Suite 2
Media, PA 19063-3433

Phone

(610) 565-0670

Fax

(610) 565-7706

NPI assigned

Oct 13, 2006

Last updated

Apr 5, 2011By the provider in NPPES

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 4

Other names 1

• Miss Maryellen Dougherty Former name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Restoration Physical Therapy LLCGroup PAC ID 4284818956, 2 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Restoration Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Media, PA
  • NPI 1174826184

  Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official
• Pain Relief and Physical Therapy, Inc.

  • Physical Therapist
  • Havertown, PA
  • NPI 1649234923
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301961600000",
    "number": "1518057900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 E BALTIMORE PIKE",
            "address_2": "SUITE 2",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633433",
            "telephone_number": "610-565-0670",
            "fax_number": "610-565-7706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 E BALTIMORE PIKE",
            "address_2": "SUITE 2",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190633433",
            "telephone_number": "610-565-0670",
            "fax_number": "610-565-7706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MARYELLEN",
        "name_prefix": "Mrs.",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT018385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE PIN",
            "identifier": "2799524000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PIN",
            "identifier": "P00430771",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE PIN",
            "identifier": "2799524000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PIN",
            "identifier": "1928216",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYELLEN",
            "last_name": "DOUGHERTY",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elina Dorfman-Levy, O.D
• Cassandra Doria
• Bernadette Dougherty, PSYD
• Kaitlyn Dougherty, M.S., LBS
• Marc N Dougherty, PHARMD
• Mickenzie Dougherty, MS, RD, LDN
• Nicole Marie Dougherty
• Thomas Charles Dowd, M.D.
• Michele Downie, PHD
• Dr. Jessica Burman, PLLC

• Physical Therapist in Media, PA
• Providers in Media, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; 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.