Provider Demographics
NPI:1679545255
Name:DOMBOSKI, KEVIN ANDREW (ATC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANDREW
Last Name:DOMBOSKI
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 JO APTER PL
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-9217
Mailing Address - Country:US
Mailing Address - Phone:410-635-2706
Mailing Address - Fax:
Practice Address - Street 1:1 WINNING DR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4776
Practice Address - Country:US
Practice Address - Phone:410-701-4075
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer