Provider Demographics
NPI:1891128625
Name:DI MANNA, DOMINIC LEE (ATC-R)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:LEE
Last Name:DI MANNA
Suffix:
Gender:M
Credentials:ATC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13253 W UTAH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4227
Mailing Address - Country:US
Mailing Address - Phone:303-912-4530
Mailing Address - Fax:
Practice Address - Street 1:13253 W UTAH CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4227
Practice Address - Country:US
Practice Address - Phone:303-912-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer