Provider Demographics
NPI:1538758727
Name:DAUGHERTY, SEAN P (PT, DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9526
Mailing Address - Country:US
Mailing Address - Phone:540-901-9501
Mailing Address - Fax:540-901-8773
Practice Address - Street 1:171 E SPRINGBROOK RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9526
Practice Address - Country:US
Practice Address - Phone:540-901-9501
Practice Address - Fax:540-901-8773
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist