MEDICARE: DEENA M DOMINY PT

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	010444	NY

General Provider Information

NPI Number	:	1912110701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENA M DOMINY PT

Provider Business Mailing Address
First Line	:	26 COYOTE LN
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-7800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 COLUMBIA ST
Second Line	:	EDDY COHOES REHAB CENTER
City	:	COHOES
State	:	NY
Zip	:	12047-2217
Country	:	US
Telephone Number	:	518-238-4069
Fax Number	:	518-238-4059

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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