Provider Demographics
NPI:1962983122
Name:DOMONDON, DOMINGO (PT)
Entity type:Individual
Prefix:
First Name:DOMINGO
Middle Name:
Last Name:DOMONDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:DOMINGO
Other - Middle Name:
Other - Last Name:DOMONDON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2170 N LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5156
Mailing Address - Country:US
Mailing Address - Phone:972-542-5500
Mailing Address - Fax:
Practice Address - Street 1:2170 N LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5156
Practice Address - Country:US
Practice Address - Phone:972-542-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist