Active NPI
Kathryn Jordan Dougherty, PT, MPT
- Physical Therapist
- West Chester, PA
National Provider Identifier
1578689790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT017564
- Practice address
- 638 Brandywine Pkwy
West Chester, PA 19380-4278 - Phone
- (610) 436-3600
- Fax
- (610) 436-3606
- NPI assigned
- Mar 21, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT017564 | PA | Primary |
Addresses
Primary practice location
638 Brandywine Pkwy
West Chester, PA 19380-4278
Mailing address
1940 Bonita Drive
Aptos, CA 95003
Phone (831) 684-1804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1018303320001 | Medicaid | PA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT017564 | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Center | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Occupational Therapist
- Aptos, CA
- NPI 1558488361
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449014400000",
"number": "1578689790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1940 BONITA DRIVE",
"city": "APTOS",
"state": "CA",
"postal_code": "95003",
"telephone_number": "831-684-1804",
"fax_number": "831-684-1826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "638 BRANDYWINE PKWY",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193804278",
"telephone_number": "610-436-3600",
"fax_number": "610-436-3606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "KATHRYN",
"middle_name": "JORDAN",
"credential": "PT, MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-21",
"last_updated": "2015-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT017564",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1018303320001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Chester, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.