Provider Demographics
NPI:1366133571
Name:THOMAS-MCCLURLIKN, DOMINIQUE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARIE
Last Name:THOMAS-MCCLURLIKN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 FRANKLIN SQUARE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3975
Mailing Address - Country:US
Mailing Address - Phone:443-777-6766
Mailing Address - Fax:
Practice Address - Street 1:9101 FRANKLIN SQUARE DR STE 205
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3975
Practice Address - Country:US
Practice Address - Phone:443-777-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8093225200000X
PATEI006415225200000X
MDA6051225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant