Provider Demographics
NPI:1629410014
Name:DOMINGO, AMBER (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5850 POLARIS AVE
Mailing Address - Street 2:100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3182
Mailing Address - Country:US
Mailing Address - Phone:702-739-9957
Mailing Address - Fax:
Practice Address - Street 1:5850 POLARIS AVE
Practice Address - Street 2:100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3182
Practice Address - Country:US
Practice Address - Phone:702-739-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist