Healthcare Provider Details

I. General information

NPI: 1750735817
Provider Name (Legal Business Name): CASSANDRA DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 29TH ST
LOVELAND CO
80538-2561
US

IV. Provider business mailing address

2912 VIRGINIA DR
LOVELAND CO
80538-8825
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-6111
  • Fax:
Mailing address:
  • Phone: 970-213-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6671
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: