Gwendolyn Elizabeth Dougherty, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

043120-1 Issued in NY

Practice address

510 Towne Dr
Fayetteville, NY 13066-1331

Phone

(315) 637-4747

NPI assigned

Sep 28, 2018

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

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.

• Level Eleven Howell, LLC

  • Clinic/Center
  • Howell, MI
  • NPI 1376321174
  NPD
• Level Eleven Saginaw, LLC

  • Rehabilitation Clinic/Center
  • Saginaw, MI
  • NPI 1164201679
  NPD

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1740765353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S ORCHARD RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 TOWNE DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130661331",
            "telephone_number": "315-637-4747"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "159 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "NY",
            "postal_code": "131262045",
            "country_code": "US",
            "telephone_number": "315-342-9575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "GWENDOLYN",
        "middle_name": "ELIZABETH",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "043120-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Dillingham, D.D.S.
• Thomas Ditch, PHARMD
• Maria Ditullio, ED.D
• Christine Dolley, LCSW R
• Meghan L Doran
• Joseph Anthony Dowell, LPN
• Niamh Doyle, PH.D.
• Nora Doyle, RN
• Dr. Fazeli & Dr. Broumand LLC
• Mark David Dropkin, DDS

• Physical Therapist in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.