Provider Demographics
NPI:1578769329
Name:DOMENECH, MANUEL A (PT)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:DOMENECH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 TERRA CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2834
Mailing Address - Country:US
Mailing Address - Phone:432-335-5360
Mailing Address - Fax:432-335-5365
Practice Address - Street 1:1326 TERRA CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2834
Practice Address - Country:US
Practice Address - Phone:432-335-5360
Practice Address - Fax:432-335-5365
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist