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General NPI Number Information
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NPI Number | 1346902301
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Entity Type | Individual
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Provider Name | ADAM DOMOVICH DPT
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Gender | Male
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 124 MERCHANT AVE
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City | MOUNT JOY
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State | PA
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Zip | 17552-1175
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Country | US
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Telephone | 717-207-7992
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Fax | 717-392-6680
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Provider Business Mailing Address
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Address Line | 124 MERCHANT AVE
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City | MOUNT JOY
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State | PA
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Zip | 17552-1175
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Country | US
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Telephone | 717-207-7992
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Fax | 717-392-6680
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT029795
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License Number State | PA
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