Provider Demographics
NPI:1457367252
Name:DOMINGA'S THERAPY SERVICES PTR. PA.
Entity Type:Organization
Organization Name:DOMINGA'S THERAPY SERVICES PTR. PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MOT
Authorized Official - Phone:954-581-5492
Mailing Address - Street 1:1950 S.W. 37 AVE.
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-581-5492
Mailing Address - Fax:954-693-9861
Practice Address - Street 1:1950 S.W. 37 AVE.
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-581-5492
Practice Address - Fax:954-693-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3603Medicare ID - Type UnspecifiedPROVIDER NUMBER