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General NPI Number Information
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NPI Number | 1497289482
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Entity Type | Individual
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Provider Name | BRITTANY NICOLE DOMINGO MA, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 1000 VERMILLION ST BOX C688
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City | ATHENS
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State | WV
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Zip | 24712-9027
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Country | US
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Telephone | 681-422-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 595 CALDWELL ST APT A
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City | PRINCETON
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State | WV
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Zip | 24739-9410
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Country | US
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Telephone | 681-422-9113
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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