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General NPI Number Information
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NPI Number | 1740610567
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Entity Type | Individual
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Provider Name | SKYLER JOHN DOHERTY LMT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 1147 U.S. HWY 80
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-748-1506
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Fax | 912-748-1507
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Provider Business Mailing Address
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Address Line | 505 HARRIS TRAIL RD APT 2G
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4243
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Country | US
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Telephone | 912-484-2177
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Fax | 912-748-1507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT008933
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License Number State | GA
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