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General NPI Number Information
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NPI Number | 1790611440
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Entity Type | Individual
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Provider Name | LIAM PATRICK DOUGHERTY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/22/2026
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Provider Practice Location Address
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Address Line | 1306 GEMINI CIR STE 3
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City | OTTAWA
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State | IL
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Zip | 61350-1695
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Country | US
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Telephone | 815-431-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 313 21ST AVE
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City | OTTAWA
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State | IL
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Zip | 61350-3719
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Country | US
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Telephone | 815-579-0118
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070.039791
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License Number State | IL
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