Provider Demographics
NPI:1225106321
Name:DOMINICK, CARRI M (PT)
Entity Type:Individual
Prefix:MS
First Name:CARRI
Middle Name:M
Last Name:DOMINICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5175 E PACIFIC COAST HWY STE 403
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3313
Mailing Address - Country:US
Mailing Address - Phone:562-285-3449
Mailing Address - Fax:424-210-5112
Practice Address - Street 1:5175 E PACIFIC COAST HWY STE 403
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3313
Practice Address - Country:US
Practice Address - Phone:562-285-3449
Practice Address - Fax:424-210-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPT3108OtherLICENSE