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NPI Code Detail

MEDICARE: MRS. TARA DOMKOWSKI P.T., D.P.T.

MEDICARE: MRS. TARA DOMKOWSKI P.T., D.P.T.
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
1225100000XPhysical Therapist3046NE
2225100000XPhysical Therapist1888SD

General Provider Information

NPI Number : 1629376249
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA DOMKOWSKI P.T., D.P.T.
Provider Business Mailing Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number : 605-642-7996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2011
Last Update Date : 08/22/2016

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