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General NPI Number Information
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NPI Number | 1689097420
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Entity Type | Individual
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Provider Name | DOMONIQUE GOMES P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 34921 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-1969
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Country | US
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Telephone | 800-251-8998
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Fax |
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Provider Business Mailing Address
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Address Line | 34921 US HIGHWAY 19 N
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City | PALM HARBOR
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State | FL
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Zip | 34684-1969
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Country | US
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Telephone | 800-251-8998
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | PTA24533
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License Number State | FL
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