Provider Demographics
NPI:1245968213
Name:FRENCH, DOMINIQUE (PT, DPT)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:FRENCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5246
Mailing Address - Country:US
Mailing Address - Phone:847-815-3038
Mailing Address - Fax:
Practice Address - Street 1:4050 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5246
Practice Address - Country:US
Practice Address - Phone:847-815-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT6167225100000X
CAPT306094225100000X
NV6457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist