MEDICARE: KATE DOHERTY P.T., D.P.T

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	08062	LA

General Provider Information

NPI Number	:	1104248012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE DOHERTY P.T., D.P.T

Provider Business Mailing Address
First Line	:	2113 AIRLINE DR
Second Line	:	#100
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3273
Country	:	US
Telephone Number	:	318-519-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	2113 AIRLINE DR
Second Line	:	#100
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3273
Country	:	US
Telephone Number	:	318-519-3088
Fax Number	:

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

Provider Enumeration Date	:	01/11/2014
Last Update Date	:	01/11/2014

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