Provider Demographics
NPI:1912247198
Name:DOMINICK, FRANK T III (CP)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:T
Last Name:DOMINICK
Suffix:III
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-0243
Mailing Address - Country:US
Mailing Address - Phone:877-393-1414
Mailing Address - Fax:570-743-5215
Practice Address - Street 1:435 RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3722
Practice Address - Country:US
Practice Address - Phone:877-393-1414
Practice Address - Fax:570-743-5215
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018173000003Medicaid
PA0018173000003Medicaid
PA1295310001Medicare PIN