Provider Demographics
NPI:1932891900
Name:HOWARD, DOMINIQUE MARKUIS
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARKUIS
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PURLIEU DR APT 202
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2078
Mailing Address - Country:US
Mailing Address - Phone:757-634-0100
Mailing Address - Fax:
Practice Address - Street 1:508 PURLIEU DR APT 202
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2078
Practice Address - Country:US
Practice Address - Phone:757-634-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist