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General NPI Number Information
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NPI Number | 1760850879
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Entity Type | Individual
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Provider Name | ELIZABETH DOUGHTY PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 630 OCEAN AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2704
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Country | US
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Telephone | 207-221-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 12 STRAWBERRY HILL RD
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1443
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Country | US
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Telephone | 508-735-7507
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4750
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License Number State | ME
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