Provider Demographics
NPI:1871731752
Name:DOHERTY, ELENA (DPT)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
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 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:744 CHRISTIANA ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-368-4841
Practice Address - Fax:302-368-4843
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1871731752Medicaid
DE1871731752OtherDPCI
299622OtherUNISON
DE3775683000OtherIBC
DE144024ZB82Medicare PIN