Provider Demographics
NPI:1124340658
Name:DOTY, KATHRYN L (MPT)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:DOTY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:DOTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 BRONZE POINTE N
Mailing Address - Street 2:STE. B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 BRONZE POINTE N
Practice Address - Street 2:STE. B
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1197
Practice Address - Country:US
Practice Address - Phone:618-235-6814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IL070.017538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist