Provider Demographics
NPI:1891187407
Name:DOMINGUEZ, RYAN CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5477
Mailing Address - Country:US
Mailing Address - Phone:888-317-0494
Mailing Address - Fax:888-317-0495
Practice Address - Street 1:5570 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5477
Practice Address - Country:US
Practice Address - Phone:888-317-0494
Practice Address - Fax:888-317-0495
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist