Provider Demographics
NPI:1275821084
Name:DOMINGUES, HEATHER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:DOMINGUES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROUTE 18 STE 39
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1912
Mailing Address - Country:US
Mailing Address - Phone:732-254-3971
Mailing Address - Fax:732-254-5291
Practice Address - Street 1:300 ROUTE 18 STE 39
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1912
Practice Address - Country:US
Practice Address - Phone:732-254-3971
Practice Address - Fax:732-254-5291
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01401800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist