Provider Demographics
NPI:1881555605
Name:DAUGHERTY, EVONIE LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:EVONIE
Middle Name:LEIGH
Last Name:DAUGHERTY
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 1:210 E GRAY ST STE 807
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3927
Mailing Address - Country:US
Mailing Address - Phone:502-587-9350
Mailing Address - Fax:502-587-9351
Practice Address - Street 1:210 E GRAY ST STE 807
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3927
Practice Address - Country:US
Practice Address - Phone:502-587-9350
Practice Address - Fax:502-587-9351
Is Sole Proprietor?:No
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY009448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist