Provider Demographics
NPI:1609154236
Name:ADAMS-DOMINGUEZ, JESSICA (DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ADAMS-DOMINGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NW 87TH AVE
Mailing Address - Street 2:STE 22
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1621
Mailing Address - Country:US
Mailing Address - Phone:305-592-5555
Mailing Address - Fax:305-592-6067
Practice Address - Street 1:2600 NW 87TH AVE
Practice Address - Street 2:STE 22
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1621
Practice Address - Country:US
Practice Address - Phone:305-592-5555
Practice Address - Fax:305-592-6067
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist