Provider Demographics
NPI:1326783614
Name:TURNER, DOMINIC-MIKAL J
Entity Type:Individual
Prefix:
First Name:DOMINIC-MIKAL
Middle Name:J
Last Name:TURNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 E WILSON PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4915
Mailing Address - Country:US
Mailing Address - Phone:120-221-5932
Mailing Address - Fax:
Practice Address - Street 1:2009 E WILSON PL
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4915
Practice Address - Country:US
Practice Address - Phone:120-221-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2000068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist