Active NPI
Colleen Marie Doherty, PT
- Physical Therapist
- Brockton, MA
National Provider Identifier
1568616464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 18333
- Practice address
- 888 N Main St
Brockton, MA 02301-1668 - Phone
- (508) 587-6556
- Fax
- (508) 588-1694
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 18333 | MA | Primary |
| Physical Therapist | 225100000X | PT33051 | CA | |
| Physical Therapist | 225100000X | 2757 | HI | |
| Physical Therapist | 225100000X | PT015950 | PA | |
| Physical Therapist | 225100000X | 10513 | NC | |
| Physical Therapist | 225100000X | 1178633 | TX |
Addresses
Primary practice location
888 N Main St
Brockton, MA 02301-1668
Mailing address
2900 Charlevoix Dr SE
Suite 200
Grand Rapids, MI 49546-7085
Phone (610) 334-4893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10513 | NC | MD | Professional Counselor |
| 18333 | MA | MD | Pharmacist |
| PT33051 | CA | MD | Physical Therapist |
| 2757 | HI | MD | Physical Therapist |
| PT015950 | PA | MD | Physical Therapist |
| 1178633 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1568616464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 CHARLEVOIX DR SE",
"address_2": "SUITE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495467085",
"telephone_number": "610-334-4893",
"fax_number": "800-325-1326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 N MAIN ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011668",
"telephone_number": "508-587-6556",
"fax_number": "508-588-1694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "COLLEEN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "18333",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT33051",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "2757",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT015950",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "10513",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1178633",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.