MEDICARE: MR. ROBERT L DOUGHER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5165580-2401	UT

General Provider Information

NPI Number	:	1669458220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT L DOUGHER P.T.

Provider Business Mailing Address
First Line	:	3665 S 8400 W
Second Line	:	SUITE 210
City	:	MAGNA
State	:	UT
Zip	:	84044-2214
Country	:	US
Telephone Number	:	801-250-6733
Fax Number	:	801-250-5038

Provider Business Practice Location Address
First Line	:	3665 S 8400 W
Second Line	:	SUITE 210
City	:	MAGNA
State	:	UT
Zip	:	84044-2214
Country	:	US
Telephone Number	:	801-250-6733
Fax Number	:	801-250-5038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	03/24/2010

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Directions to “ MR. ROBERT L DOUGHER P.T.” Practice Location

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