Dominique Y Cordova, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA28180 Issued in FL

Practice address

435 NW Rutland Rd
Mount Juliet, TN 37122-8700

Phone

(615) 773-6111

NPI assigned

Jul 15, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1184358996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9925 SW 82ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331562513",
            "telephone_number": "305-450-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 NW RUTLAND RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228700",
            "telephone_number": "615-773-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA",
        "first_name": "DOMINIQUE",
        "middle_name": "Y",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-15",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA28180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Irene Connolly, LMSW
• Clare Connors, DMD
• Jordan Taylor Cook
• Ralph Douglas Cook, LMFT
• Cassandra Smith Cooper, M.ED.
• Cara Corning, D.D.S
• Courtney Lynne Coronado
• Atalie Marie Cortez
• Emily Brooke Corum
• Cosmetic Creations PLLC (Joshua Gunnels DDS PLLC)

• Physical Therapy Assistant in Mount Juliet, TN
• Providers in Mount Juliet, TN by specialty
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.