Healthcare Provider Details

I. General information

NPI: 1003548942
Provider Name (Legal Business Name): EMILY DOOLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 THIMBLE SHOALS BLVD STE 4C
NEWPORT NEWS VA
23606-4217
US

IV. Provider business mailing address

729 THIMBLE SHOALS BLVD STE 4C
NEWPORT NEWS VA
23606-4217
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-2932
  • Fax:
Mailing address:
  • Phone: 757-873-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305215054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: