Provider Demographics
NPI:1619166048
Name:DOMADO, LORAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:
Last Name:DOMADO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LORAINE
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3290 NORTH RIDGE ROAD
Mailing Address - Street 2:SUITE 290 EXECUTIVE CENTER II
Mailing Address - City:ELLICOTT
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-750-9006
Mailing Address - Fax:
Practice Address - Street 1:3201 W. COMMERCIAL BLVD.
Practice Address - Street 2:SUITE 116
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist