MEDICARE: DOMINICA S BARABE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4555	NM

General Provider Information

NPI Number	:	1730684119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINICA S BARABE DPT

Provider Business Mailing Address
First Line	:	6900 SUERTE PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 SUERTE PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1965
Country	:	US
Telephone Number	:	575-799-8052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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Directions to “ DOMINICA S BARABE DPT” Practice Location

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