Healthcare Provider Details

I. General information

NPI: 1043127962
Provider Name (Legal Business Name): KILEY DOERZBACHER DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 UNIVERSITY DR STE 2B
DURHAM NC
27707-2527
US

IV. Provider business mailing address

1313 MEADSTON DR
DURHAM NC
27712-9725
US

V. Phone/Fax

Practice location:
  • Phone: 919-627-6700
  • Fax:
Mailing address:
  • Phone: 513-703-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP25263
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: