Lori Dominiczak, PT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

2714-024 Issued in WI

Practice address

4002 W Cherrywood LN
Brown Deer, WI 53209-1002

Phone

(414) 378-3375

NPI assigned

Jul 27, 2007

Last updated

Jul 27, 2007By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dominiczak Therapy Associates, LLC

  • Physical Therapist
  • Brown Deer, WI
  • NPI 1730327073
  Authorized official Same address or phone

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185494400000",
    "number": "1548450372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 W CHERRYWOOD LN",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 W CHERRYWOOD LN",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091002",
            "telephone_number": "414-378-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINICZAK",
        "first_name": "LORI",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2007-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "WI",
            "license": "2714-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40440700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stan Dillon
• Divine Healthcare Services
• Divine Personal Care Agency
• Carla Dobre-Chastain
• Dominiczak Therapy Associates, LLC
• Michelle Lee Donovan, LPC
• Hinnougbe Arnaud Dossou Houegbe
• Kellie Dossou Houegbe
• Letitia Dotson
• Dotties Loving Care LLC

• Pediatric Physical Therapist in Brown Deer, WI
• Providers in Brown Deer, WI by specialty
• Pediatric Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; 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.