Provider Demographics
NPI:1831518349
Name:DOMINGUEZ, FELICIA (LMT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 CARROLLWOOD PLACE CIRCLE
Mailing Address - Street 2:4-302
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624
Mailing Address - Country:US
Mailing Address - Phone:813-393-8341
Mailing Address - Fax:
Practice Address - Street 1:3902 CARROLLWOOD PLACE CIR
Practice Address - Street 2:4-302
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-3062
Practice Address - Country:US
Practice Address - Phone:813-393-8341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist