| NPI | 1952458275 |
|---|---|
| Former Name | TRACY LYNN DOHERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J10000408) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 18976) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2013-03-04 |