Provider Demographics
NPI:1487864955
Name:IRWIN, DOMINIC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:IRWIN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RUDY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8036
Mailing Address - Country:US
Mailing Address - Phone:419-342-1724
Mailing Address - Fax:419-342-1797
Practice Address - Street 1:20 MORRIS RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1152
Practice Address - Country:US
Practice Address - Phone:419-342-1724
Practice Address - Fax:419-342-1797
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.011438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist