Provider Demographics
NPI:1336280882
Name:DOMINIANNI, PETER (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DOMINIANNI
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4249 BLUFF HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8322
Mailing Address - Country:US
Mailing Address - Phone:561-531-9333
Mailing Address - Fax:
Practice Address - Street 1:11223 EDGEWATER CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8831
Practice Address - Country:US
Practice Address - Phone:561-531-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0223692251P0200X
FLPT245152251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics