Provider Demographics
NPI:1497289482
Name:DOMINGO, BRITTANY NICOLE (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 CALDWELL ST APT A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-9410
Mailing Address - Country:US
Mailing Address - Phone:681-422-9113
Mailing Address - Fax:
Practice Address - Street 1:1000 VERMILLION ST
Practice Address - Street 2:BOX C688
Practice Address - City:ATHENS
Practice Address - State:WV
Practice Address - Zip Code:24712-9027
Practice Address - Country:US
Practice Address - Phone:681-422-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer