Dominica Sourial, DPT
Individual provider Active NPI Physical Therapist · Gladstone, NJ
NPI 1689175796 · NPPES record last updated Jul 17, 2023
Key facts
- NPI
- 1689175796
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 40QA01776900 (NJ)
- Practice address
- 100 US-206
Gladstone, NJ 07934 - Phone
- (212) 733-2323
- NPI assigned
- Feb 23, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01776900 | NJ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Madison Medical and Sports Rehabilitation L.L.C | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 40QA01776900 | NJ | Yes |
Addresses
Primary practice location
100 US-206
Gladstone, NJ 07934
Mailing address
125 Mountain Ave
Gillette, NJ 07933-1608
Phone (908) 938-7898
Other names
- Dr. Dominica Hanna
Other providers in Gladstone, NJ
All providers in Gladstone, NJ · Physical Therapist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.