MEDICARE: MS. ALLYSON H DAUGHERTY PT, CLT, CFM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7478	NC

General Provider Information

NPI Number	:	1013024645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLYSON H DAUGHERTY PT, CLT, CFM

Provider Business Mailing Address
First Line	:	308 GREENVILLE BLVD SE STE B1
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5758
Country	:	US
Telephone Number	:	252-215-5225
Fax Number	:	252-215-5226

Provider Business Practice Location Address
First Line	:	308 GREENVILLE BLVD SE
Second Line	:	SUITE B-3
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5758
Country	:	US
Telephone Number	:	252-215-5225
Fax Number	:	252-215-5226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	12/11/2024

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