Provider Demographics
NPI:1255084471
Name:DOHERTY, SUSAN V (DPT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:V
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 CHISEL RDG
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3967
Mailing Address - Country:US
Mailing Address - Phone:281-685-3664
Mailing Address - Fax:
Practice Address - Street 1:3651 WESLAYAN ST STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6638
Practice Address - Country:US
Practice Address - Phone:713-850-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist