Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251X0800X | Physical Therapist - Orthopedic | 23264 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 23264 | CA |
NPI | 1053656041 |
---|---|
Provider Name | Ms. Annette N Doherty |
First Address | Burlingame, CA 94010-4093 |
Second Address | Burlingame, CA 94010-4093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2012 |
Last Update Date | 15/12/2021 |