Andrew Dominguez, PT, DPT
Individual provider Active NPI Orthopedic Physical Therapist · Selma, TX
NPI 1447547799 · NPPES record last updated Jul 7, 2011
Key facts
- NPI
- 1447547799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 1207596 (TX)
- Practice address
- 8335 Agora Pkwy # 100
Selma, TX 78154-1383 - Phone
- (210) 658-8483
- NPI assigned
- Jul 7, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110914000771 | TX | Practitioner - Physical Therapist in Private Practice | 8325219702 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1207596 | TX | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lawton Indian Hospital | Current |
Accepting new patients |
Locations
1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 1207596 | TX | Yes |
Addresses
Primary practice location
8335 Agora Pkwy # 100
Selma, TX 78154-1383
Mailing address
8335 Agora Pkwy # 100
Selma, TX 78154-1383
Phone (210) 658-8483
Other providers in Selma, TX
- Jenna Kamaile Nurial Dacalio
- Daniel & Max, LLC
- Lauren Diane Delgado
- Robert Nichael Dobbins
- Jennifer Dohogne
- Alexis Morgan Eichhorn
- Sheron Bonice Encarnacion
- Eyemart Express LLC
- Fannin County Hospital Authority
- Feel Fit Physical Therapy
All providers in Selma, TX · Orthopedic Physical Therapist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.