Provider Demographics
NPI:1871979609
Name:DAUGHERTY, KRISTIN LOIS (DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LOIS
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 1:3611 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-6625
Mailing Address - Country:US
Mailing Address - Phone:580-704-8150
Mailing Address - Fax:
Practice Address - Street 1:1414 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5740
Practice Address - Country:US
Practice Address - Phone:405-703-4003
Practice Address - Fax:405-703-2279
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist