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General NPI Number Information
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NPI Number | 1144855933
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Entity Type | Individual
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Provider Name | SANDRA COLLINS DOMANSKI PT
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Gender | Female
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1750 LONGLEAF BLVD # 5&6
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City | LAKE WALES
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State | FL
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Zip | 33859-2504
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Country | US
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Telephone | 863-678-0705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550
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City | WAVERLY
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State | FL
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Zip | 33877-0550
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Country | US
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Telephone | 863-521-0402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4390
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License Number State | FL
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