Provider Demographics
NPI:1528686912
Name:DOCHTERMAN, EMILY M (ATC, ACSM-EP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:DOCHTERMAN
Suffix:
Gender:F
Credentials:ATC, ACSM-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28720 STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MO
Mailing Address - Zip Code:63435-3005
Mailing Address - Country:US
Mailing Address - Phone:660-341-9535
Mailing Address - Fax:
Practice Address - Street 1:3300 POINSETT HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29613-3005
Practice Address - Country:US
Practice Address - Phone:660-341-9535
Practice Address - Fax:864-294-3338
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT033122081S0010X
390200000X
20000509272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program