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NPI Code Detail

MEDICARE: DOMINIC ROBERT AFFUSO

MEDICARE: DOMINIC ROBERT AFFUSO
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
1225100000XPhysical Therapist5333AZ

General Provider Information

NPI Number : 1952059552
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIC ROBERT AFFUSO
Provider Business Mailing Address
First Line : 31611 N 132ND DR
Second Line :
City : PEORIA
State : AZ
Zip : 85383-7958
Country : US
Telephone Number : 480-340-1750
Fax Number :
Provider Business Practice Location Address
First Line : 17300 N 88TH AVE
Second Line :
City : PEORIA
State : AZ
Zip : 85382-3501
Country : US
Telephone Number : 480-340-1750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2022
Last Update Date : 03/13/2022

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Directions to “ DOMINIC ROBERT AFFUSO ” Practice Location

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