Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT24515 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | 022369 | NY |
NPI | 1336280882 |
---|---|
Provider Name | Mr. Peter Dominianni |
First Address | Wellington, FL 33449-8322 |
Second Address | Wellington, FL 33414-8831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 29/06/2020 |