Healthcare Provider Details

I. General information

NPI: 1790611440
Provider Name (Legal Business Name): LIAM PATRICK DOUGHERTY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 GEMINI CIR STE 3
OTTAWA IL
61350-1695
US

IV. Provider business mailing address

313 21ST AVE
OTTAWA IL
61350-3719
US

V. Phone/Fax

Practice location:
  • Phone: 815-431-9980
  • Fax:
Mailing address:
  • Phone: 815-579-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.039791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: