Provider Demographics
NPI:1013019041
Name:DOMINO, THOMAS ALAN (PT, SCS, CSCS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:DOMINO
Suffix:
Gender:M
Credentials:PT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 DELFORD DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1290
Mailing Address - Country:US
Mailing Address - Phone:214-387-0552
Mailing Address - Fax:
Practice Address - Street 1:1101 OHIO DR STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5331
Practice Address - Country:US
Practice Address - Phone:972-985-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11086862251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
8T1156OtherBCBS
8A9823Medicare ID - Type Unspecified