MEDICARE: MR. MARTIN HENNINGER DOMINGUEZ DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2305004476	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407855513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN HENNINGER DOMINGUEZ DPT

Provider Business Mailing Address
First Line	:	3200 LADY MARIAN LN
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-1178
Country	:	US
Telephone Number	:	804-677-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 WATERFORD LAKE DR STE 103
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3994
Country	:	US
Telephone Number	:	804-249-8277
Fax Number	:	804-249-9690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/02/2022

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Directions to “ MR. MARTIN HENNINGER DOMINGUEZ DPT” Practice Location

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