Provider Demographics
NPI:1295027894
Name:CHRISTINE DOMBROSKI, PT LLC
Entity Type:Organization
Organization Name:CHRISTINE DOMBROSKI, PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMBROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-205-6404
Mailing Address - Street 1:313 MONTCLAIRE DR SE APT 5
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2676
Mailing Address - Country:US
Mailing Address - Phone:505-205-6404
Mailing Address - Fax:
Practice Address - Street 1:313 MONTCLAIRE DR SE APT 5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2676
Practice Address - Country:US
Practice Address - Phone:505-205-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2881261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center