Provider Demographics
NPI:1124244173
Name:DOUGHERTY, SUSAN K (CMT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1357
Mailing Address - Country:US
Mailing Address - Phone:717-898-7178
Mailing Address - Fax:
Practice Address - Street 1:3153 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1357
Practice Address - Country:US
Practice Address - Phone:717-898-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist