Provider Demographics
NPI:1346902301
Name:DOMOVICH, ADAM (DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DOMOVICH
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MERCHANT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-1175
Mailing Address - Country:US
Mailing Address - Phone:717-207-7992
Mailing Address - Fax:717-392-6680
Practice Address - Street 1:124 MERCHANT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1175
Practice Address - Country:US
Practice Address - Phone:717-207-7992
Practice Address - Fax:717-392-6680
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0297952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic