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General NPI Number Information
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NPI Number | 1396174017
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Entity Type | Individual
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Provider Name | MRS. DEANNA DOMNISCH
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 2307 S DALE MABRY HWY STE F
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City | TAMPA
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State | FL
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Zip | 33629-6322
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Country | US
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Telephone | 813-374-9508
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 S HIMES AVE APT 801
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City | TAMPA
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State | FL
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Zip | 33611-2622
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Country | US
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Telephone | 716-696-0212
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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 | 2305208347
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT871510
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT38897
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License Number State | FL
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