Provider Demographics
NPI:1790731370
Name:RASONABE STO DOMINGO, MARIA SHEILA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SHEILA
Last Name:RASONABE STO DOMINGO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ARDSLEY SQ
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2303
Mailing Address - Country:US
Mailing Address - Phone:732-952-3463
Mailing Address - Fax:
Practice Address - Street 1:560 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3307
Practice Address - Country:US
Practice Address - Phone:908-355-3358
Practice Address - Fax:908-355-6614
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00984400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091993TV9Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID