Provider Demographics
NPI:1063572741
Name:DAUGHERTY, FRANK ELLIOTT (PT)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:ELLIOTT
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35983 JIM CLARK RD
Mailing Address - Street 2:
Mailing Address - City:DOZIER
Mailing Address - State:AL
Mailing Address - Zip Code:36028-7320
Mailing Address - Country:US
Mailing Address - Phone:334-388-5681
Mailing Address - Fax:334-388-5681
Practice Address - Street 1:105 S WHALEY ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-2105
Practice Address - Country:US
Practice Address - Phone:334-493-4555
Practice Address - Fax:334-493-7449
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist