Healthcare Provider Details

I. General information

NPI: 1558274266
Provider Name (Legal Business Name): LUIS DOMINGUEZ DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FIFTH AVE
PELHAM NY
10803-1204
US

IV. Provider business mailing address

100 DEKRUIF PL APT 2B
BRONX NY
10475
US

V. Phone/Fax

Practice location:
  • Phone: 914-738-1748
  • Fax: 914-738-1749
Mailing address:
  • Phone: 917-736-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: