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General NPI Number Information
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NPI Number | 1871979609
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Entity Type | Individual
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Provider Name | KRISTIN LOIS DAUGHERTY DPT
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Gender | Female
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1414 N EASTERN AVE
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City | MOORE
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State | OK
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Zip | 73160-5740
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Country | US
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Telephone | 405-703-4003
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Fax | 405-703-2279
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Provider Business Mailing Address
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Address Line | 3611 RIVER RIDGE DR
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City | NEWCASTLE
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State | OK
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Zip | 73065-6625
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Country | US
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Telephone | 580-704-8150
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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 | 4937
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License Number State | OK
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